Significant elevations in serum lipase in the emergency department: When it is not pancreatitis!

Kahil, Karine; Halabi, Maan El; Daher, Halim Bou; Rustom, Luma Basma O.; Marrache, Majd; Ichkhanian, Yervant; Sayed, Mazen El; Sharara, Ala I.

doi:10.1016/j.ajem.2019.10.014

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…After reviewing the clinical cases, certain issues are worth analyzing: Abdominal pain, a cardinal symptom in most cases of AP, may be due to SARS-CoV-2 injury to the GI tract, and it may not be possible to differentiate it from the AP pain; SARS-CoV-2 pancreatic injury causing serum lipase and/or amylase elevation has been recognized, mainly in severe cases, but per se it is not diagnostic of AP; serum lipase elevation is not specific of pancreatic pathology, and can be seen in other GI pathology, including gastroparesis, gastritis, enteritis and colitis[ 16 ], which are also recognized to be part of the COVID-19 clinical picture; and although infrequent, there are cases of severe AP due to respiratory dysfunction in COVID-19 patients without abnormalities on CECT scan (most severe cases exhibit local peripancreatic complications).…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis and COVID-19: A literature review

Sá

Soares

Rocha

2021

WJGS

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BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19), and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARS-CoV-2, but the mechanisms of pancreatic injury are still a subject of debate. There is also controversy on whether SARS-CoV-2 can cause AP or if it is an epiphenomenon. AIM To review and to explore the relationship between SARS-CoV-2 infection and AP, and to provide an overview of the existing literature on possible mechanisms of SARS-CoV-2-induced pancreatic lesion. METHODS A systematic review was conducted in accordance with PRISMA guidelines for papers on SARS-CoV-2 infection and AP. A narrative review on possible mechanisms of SARS-CoV-2-induced pancreatic lesion was also performed. RESULTS A literature review revealed a growing body of evidence on SARS-CoV-2-induced pancreatic lesions including the mechanisms of direct virus-mediated injury, systemic inflammatory response and circulating pro-inflammatory interleukins, virus-induced lipotoxicity, and drug-induced injury. A systematic review of the literature revealed 22 cases of AP in COVID-19 patients. However, limitations of the reported cases make it difficult to establish a causal relationship between SARS-CoV-2 infection and AP. All of the studies agreed on special monitoring and surveillance of this subset of patients due to the still unknown clinical progression, therapeutic implications, and prognosis. CONCLUSION AP should be considered in COVID-19 patients, especially in those exhibiting abdominal pain and systematic, and complete reporting of these cases should be general practice. However, there is still insufficient evidence showing that COVID-19 can cause AP or negatively impact prognosis. Additional studies are needed to clarify the relationship between these two entities and their theragnostic significance.

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Section: Discussionmentioning

confidence: 99%

Acute pancreatitis and COVID-19: A literature review

Sá

Soares

Rocha

2021

WJGS

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“…The abdominal pain in patients with COVID-19 may be due to SARS-CoV-2 injury to the GI tract rather than AP, and it may not be possible to differentiate them. Also, SARS-CoV-2 causing serum lipase and/or amylase elevation is not diagnostic for AP because serum lipase elevation is not specific for pancreatic pathology, and can be seen in other GI pathology, including gastroparesis, gastritis, enteritis, and colitis [ 57 ] which are also recognized to be part of the COVID-19 clinical picture. Hence, it cannot definitely be concluded that the abdominal pain and lipase and/or amylase elevations in these patients were secondary to AP and not some other GI pathology blurring the relationship between COVID-19 infection causing AP.…”

Section: Reviewmentioning

confidence: 99%

Acute Pancreatitis Related to COVID-19 Infection: A Systematic Review and Analysis of Data

Aziz¹,

Aziz²,

Saleem³

et al. 2022

Cureus

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There is increasing literature mentioning severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19 infection) causing acute pancreatitis (AP). It is hypothesized that SARS-Cov-2 causes pancreatic injury either by direct cytotoxic effect of the virus on pancreatic cells through the angiotensin-converting enzyme 2 (ACE2) receptors - the main receptors for the virus located on pancreatic cells - or by the cytokine storm that results from COVID-19 infection or a component of both. Many viruses are related to AP including mumps, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and as data evolves SARS-CoV-2 virus may be one of them as well. We conducted a systematic literature review to explore the current literature and provide an overview of the evidence of AP in COVID-19 infection. We studied the presence of AP in patients with SARS-CoV-2 infection and calculated the time of diagnosis of SARS-CoV-2 infection with respect to the time of diagnosis of AP. We also studied the age, gender, clinical manifestations, time of onset of symptoms, laboratory values, imaging findings, mortality, length of stay, comorbidities, need for Intensive Care Unit (ICU) care, and excluded any other common causes of AP. We included 40 articles comprising 46 patients. All patients had a positive SARS-CoV-2 polymerase chain reaction (PCR) test and all patients had AP as per Atlanta’s criteria. The most common clinical presentation was abdominal pain in 29 (63.0%). Edematous pancreas was the most common Computed Tomography Abdomen Pelvis (CTAP) scan finding in these patients (35 patients). Seventeen (37%) patients required ICU admission and six (13%) patients died. Our study provides an important overview of the available data on AP in COVID-19 patients and concludes that AP is an important complication in COVID-19 infection and should be considered as an important differential in patients with COVID-19 infection who complain of abdominal pain.

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“…Of 614 patients presenting to an ED who had an elevated lipase level, 75 were diagnosed with AP (12.2%), and 28 (4.6%) had a serum lipase >5*ULN despite no evidence of pancreatitis. 2 Elevation of serum lipase was present in 11.4-20.4% of asymptomatic individuals with type 2 DM (T2DM) as part of baseline screening for a drug trial, with 0.4-2.1% having a serum lipase >3*ULN (Table 1). 3…”

Section: Diagnosing Acute Pancreatitismentioning

confidence: 99%

Review article: Diagnosing acute pancreatitis in diabetes mellitus

Morton

2021

Emerg Medicine Australasia

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Acute pancreatitis is a common reason for presentation to EDs. The criteria for diagnosis of acute pancreatitis are defined by the revised Atlanta classification. Patients with diabetes mellitus are at increased risk of acute pancreatitis. Uncomplicated diabetes mellitus, complications such as ketoacidosis and newer medications used in the treatment of hyperglycaemia may all be associated with elevated serum lipase and amylase in the absence of acute pancreatitis. Checkpoint inhibitors may also precipitate acute type 1 diabetes mellitus and be associated with elevated lipase and amylase. Finally, individuals with diabetes mellitus are at increased risk of hypertriglyceridaemic pancreatitis, which may be associated with falsely normal lipase and amylase because of laboratory interference. Awareness of these factors in individuals with diabetes mellitus presenting to EDs with symptoms suggestive of acute pancreatitis is important for accurate diagnosis.

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Significant elevations in serum lipase in the emergency department: When it is not pancreatitis!

Cited by 3 publications

References 2 publications

Acute pancreatitis and COVID-19: A literature review

Acute pancreatitis and COVID-19: A literature review

Acute Pancreatitis Related to COVID-19 Infection: A Systematic Review and Analysis of Data

Review article: Diagnosing acute pancreatitis in diabetes mellitus

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