Lipase Elevation in Patients With COVID-19

Abstract

INTRODUCTION: Although coronavirus disease (COVID-19) has been associated with gastrointestinal manifestations, its effect on the pancreas remains unclear. We aimed to assess the frequency and characteristics of hyperlipasemia in patients with COVID-19. METHODS: A retrospective cohort study of hospitalized patients across 6 US centers with COVID-19. RESULTS: Of 71 patients, 9 (12.1%) developed hyperlipasemia, with 2 (2.8%) greater than 3 times upper limit of normal. No patient developed acute pancreatitis. Hyperlipasemia was not associated with poor outcomes or symptoms. DISCUSSION: Although a mild elevation in serum lipase was observed in some patients with COVID-19, clinical acute pancreatitis was not seen.

Lipotoxicity and Cytokine Storm in Severe Acute Pancreatitis and COVID-19

“…A cute pancreatitis is one of the most common conditions leading to emergency hospital admission. 1 Its variable etiologies include vascular events, 2 drugs, 3 and genetic factors, 4 but the ultimate clinical manifestation is fairly uniform. 5 It involves edema of the gland, the development of pancreatic and extrapancreatic necrosis and systemic complications leading to (multi)organ failure.…”

“…3 An increasing number of publications have reported that SARS-CoV-2 targets the pancreas resulting in elevation of serum lipase activity or rarely even frank pancreatitis. [4][5][6][7] Autopsy data suggest that the incidence of focal pancreatitis in COVID-19 may be higher than diagnosed clinically. 8 However, it is conceivable that the virus targets not only the pancreas, but also adipocytes causing increased lipolysis through the adipose triglyceride lipase (Figure 1, A).…”

Acute Pancreatitis may Occur in COVID-19 Patients with Clearance of SARS-CoV-2 in Lung: A Case Report

“…However, direct connection of acute pancreatitis with ritonavia-induced hypertriglyceridemia was only illustrated in few cases [7]. Meanwhile, COVID-19 patients with hypertriglyceridemia was not seen clinical acute pancreatitis and in this case, hypertriglyceridemia occurred after incidence of acute pancreatitis [8].…”

Letter to the editor in response to COVID-19 presenting as acute pancreatitis

“…Thirdly, elevation of pancreatic enzymes without clinical evidence of pancreatitis has also been reported in literature in patients of COVID 19 infection. A retrospective cohort study by McNabb-Baltar et al [3] in 71 patients hospitalized for COVID-19 found that, only 9 (12.1%) had hyperlipasemia (defined in this study as an elevated lipase level above the upper limit of normal (>60 U/ L)), with two cases (2.8%) having greater than 3 fold elevation but without imaging evidence of acute pancreatitis. Two additional patients with hyperlipasemia (62 U/L and 136 U/L) who underwent abdominal CT imaging had mild fat stranding around the pancreas and gallbladder (but did not meet radiologic criteria for pancreatitis) and a normal examination, respectively.…”