Patients with COVID-19 Interstitial Pneumonia Exhibit Pancreatic Hyperenzymemia and Not Acute Pancreatitis

Abstract

Background and aims: Gastrointestinal manifestations of COVID-19 have been well established, but pancreatic involvement is under debate. The aim of the study is to evaluate the presence of acute pancreatitis in COVID-19 patients and to assess the frequency of pancreatic hyperenzymemia. Methods: From April 1st 2020 to April 30th 2020, 110 consecutive patients (69 males, 41 females; mean age 63.0 years, range 24-93 years) met these criteria and were enrolled in the study.. The clinical data and serum activity of pancreatic amylase and lipase were assayed in all patients using commercially available kits. Results: None of the patients studied developed clinical signs or morphological alterations compatible with acute pancreatitis. However, it was found that 24.5% of the patients had amylase values above 53 IU/L and 16.4% had lipase values above 300 IU/. Only one patient (0.9%) had both amylase and lipase values in excess of three-fold the upper normal limit without clinical signs of pancreatitis. Conclusions: The presence of pancreatic hyperenzymemia in a patient with COVID-19 requires the management of these patients be guided by clinical evaluation and not merely by evaluation of the biochemical results.

Hyperlipasemia and Potential Pancreatic Injury Patterns in COVID-19: A Marker of Severity or Innocent Bystander?

“…The initial search yielded 52 articles. After excluding duplicates and review articles, 7 studies 3,6-10 (6 retrospective observational studies and 1 prospective observational study 11 ) were included in the pooled analysis. A flow chart depicting the study screening and selection process is presented in Supplementary Figure 1.…”

A bimodal pattern of the onset of COVID-19 related acute pancreatitis supports both the cytotoxic and immune-related pathogenesis – a systematic review

“…In their retrospective analysis, Barlass et al found markedly elevated lipase levels in 14 of 83 (17%) patients who tested positive for COVID-19 and were admitted to the hospital [12]. As pointed by Pezzili et al [13], patients with COVID-19 infection may exhibit elevation of serum levels of pancreatic enzymes but they may not satisfy the diagnostic criteria for acute pancreatitis. In their cohort of 110 COVID-19 positive patients, 24.5% of them had increased amylase levels, 16.4% had increased lipase levels, but only a single patient (0.9%) had levels above three-fold the upper limit.…”

“…In their cohort of 110 COVID-19 positive patients, 24.5% of them had increased amylase levels, 16.4% had increased lipase levels, but only a single patient (0.9%) had levels above three-fold the upper limit. None of these patients developed clinical or morphological signs of acute pancreatitis [13]. The clinical significance of increased lipase levels in patients with COVID-19 has been questioned [14,15].…”

Pancreatic Injury in Patients with SARS-Cov-2 (COVID-19) Infection: A Retrospective Analysis of CT Findings

“…Patients with COVID-19 infection may exhibit elevation of serum levels of pancreatic enzymes, but they may not develop clinical symptoms or otherwise satisfy the diagnostic criteria for acute pancreatitis [ 19 ]. This is also the reason why cases of COVID-19-induced pancreatitis are scattered [ 10 ].…”