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

Hegyi, Péter; Szakács, Zsolt; Sahin–Tóth, Miklós

doi:10.1053/j.gastro.2020.07.014

Cited by 61 publications

(66 citation statements)

References 15 publications

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“…Thus, this pathway of virus induced lipotoxicity and cytokine storm [ 28 ] can explain the pancreatic injury. In fact, the cytokine profile of both AP and COVID-19 infection has been found to be similar, with increased levels of IL-6, IL-8 and IL-10 [ 29 ].…”

Section: Pathophysiology Of Pancreatic Injurymentioning

confidence: 99%

Coronavirus disease 2019 and the pancreas

et al. 2020

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Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.

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Section: Pathophysiology Of Pancreatic Injurymentioning

confidence: 99%

Coronavirus disease 2019 and the pancreas

et al. 2020

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“…More recently, research has shown a significant similarity in cytokine elevations between patients with severe AP and those with severe COVID-19. 13 This suggests that therapeutic removal of cytokines through early supplementation with calcium and albumin may improve outcomes in patients with both diseases. 13 The concentration of glucose increases during refeeding, leading to hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

“…13 This suggests that therapeutic removal of cytokines through early supplementation with calcium and albumin may improve outcomes in patients with both diseases. 13 The concentration of glucose increases during refeeding, leading to hyperglycemia. As a consequence, insulin secretion increases, stimulating the anabolic pathway and leading to intracellular uptake of phosphate, which is significant for cellular metabolism of macronutrients for energy production.…”

Section: Introductionmentioning

confidence: 99%

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Refeeding syndrome in a woman with pancreatitis: a case report

et al. 2021

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Refeeding syndrome can occur in malnourished patients with acute pancreatitis who have electrolyte imbalances. Refeeding syndrome is characterized by severe electrolyte imbalances (mainly hypophosphatemia, hypomagnesemia, and hypokalemia), vitamin deficiency (mainly thiamine deficiency), fluid overload, and salt retention resulting in organ dysfunction and cardiac arrhythmias. We herein report a case involving a patient with severe pancreatitis and gallbladder stones who developed refeeding syndrome with shock and loss of consciousness. The patient was treated by opportune vitamin and electrolyte supplementation therapy and showed substantial improvement after 2 weeks of hospitalization, gaining the ability to eat small bites of solid food orally. Early diagnosis and treatment of refeeding syndrome may reduce morbidity and mortality in patients with acute pancreatitis. Patients should be fasted only if alimentation is contraindicated, and electrolyte values must be closely monitored.

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“…Hypocalcemia [ 3 ], hypoalbuminemia [ 4 ], and the cytokine storm [ 5 ] including IL-6 elevation [ 4 , 6 ] can be induced by the unbound [ 4 ] unsaturated fatty acids [ 7 ] released during severe COVID-19 infection. This occurs due to adipose lipolysis (in agreement with obesity worsening COVID-19 [ 8 ]), and causes distributive shock, renal failure and arrhythmias via endothelial, epithelial and cardiomyocyte injury respectively [ 4 ].…”

mentioning

confidence: 99%