Pancreatic damage in COVID‐19: Why? How?

Abstract

Object We aimed to evaluate the elevation of amylase and lipase enzymes in coronavirus disease 2019 (COVID‐19) patients and their relationship with the severity of COVID‐19. Method In this study, 1378 patients with COVID‐19 infection were included. Relation of elevated amylase and lipase levels and comorbidities with the severity of COVID‐19 was analysed. The effects of haemodynamic parameters and organ failure on pancreatic enzymes and their relations with prognosis were statistically analysed. Results The 1378 patients comprised of 700 (51.8%) men and 678 (%49.2) women. Of all patients, 687 (49.9%) had mild and 691 (50.1%) patients had severe COVID‐19 infection. Amylase elevation at different levels occurred in 316 (%23) out of 1378 patients. In these patients, the amylase levels increased one to three times in 261 and three times in 55 patients. Pancreatitis was detected in only six (%1.89) of these patients according to the Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels were significantly associated with the severity of COVID‐19 (odds ratio [OR]: 4.37; P < .001). Moreover, diabetes mellitus (DM; OR: 1.82; P = .001), kidney failure (OR: 5.18; P < .001), liver damage (OR: 6.63; P < .001), hypotension (OR: 6.86; P < .001) and sepsis (OR: 6.20; P = .008) were found to be associated with mortality from COVID‐19. Conclusion Elevated pancreatic enzyme levels in COVID‐19 infections are related to the severity of COVID‐19 infection and haemodynamic instability. In a similar way to other organs, the pancreas can be affected by severe COVID‐19 infection.

Prevalence and Outcomes of Pancreatic Enzymes Elevation in Patients With COVID-19: A Meta-Analysis and Systematic Review

“…Since the heterogeneity was significant, we performed a sensitivity analysis to explore the impact of each study. The result showed that two studies ( 13 , 23 ) affected the pooled OR (odds ratio) of mortality ( Supplementary Figure 2 ). After removing any one of the two studies, the I 2 did not decrease significantly (78.6–87.7%).…”

“…Six studies ( 13 , 14 , 21 , 22 , 25 , 26 ) with samples more than ten patients reported AP diagnosis according to the revised Atlanta classification of acute pancreatitis 2012 ( 30 ), covering 1,705 patients with elevated PE > 3 × ULN, of which 182 developed AP. The prevalence of AP ranged from 1.3 to 18.8%.…”

“…Ten studies ( 13 , 14 , 16 , 21 – 23 , 25 – 27 , 29 ) reported the mortality associated with elevated PE. A total of 2,4207 participants including 3,142 participants in the elevated PE group, of which 760 participants died, and 2,1065 participants in the normal PE group, of which 2,033 participants died were included in the analysis.…”

“…Subsequently, an increasing number of studies reported the similar findings. Since the critically ill COVID-19 patients often experience severe systemic inflammatory, shock, microcirculatory disturbance and renal failure, some scholars believed that PE elevation might be associated with pancreatic ischemic injury ( 13 – 15 ), and the elevated PE can serve as a surrogate marker for poor prognosis of COVID-19 patients. However, in different studies, due to the different sample sizes and definition of PE elevation, the prevalence of PE elevation varied greatly, and the clinical significance of it was still controversial ( 14 , 16 ).…”

Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

“…In comparison, in this study, GGT values in the group with high lipase activity were significantly higher than in the group with normal lipase activity; however, GGT was not one of the independent factors that was determined to predict mortality successfully in this patient population. In a study including 1378 COVID-19 patients, it was reported that high amylase activity was associated with severe disease outcomes [ 31 ]. In comparison, in this study, a weak correlation was found between high amylase activity measured at admission and mortality.…”