Patients with acute pancreatitis, COVID-19 at high risk for multiorgan failure
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There may be a relationship between acute pancreatitis and COVID-19 that may lead to patients having a higher risk for multiorgan failure, morbidity and mortality, according to a study in Gastroenterology.
“A better understanding of this relationship will better guide clinicians on early management strategies and focus medical resources toward those patients at risk for worse outcomes,” Ahmed Dirweesh, MD, from the division of gastroenterology, hepatology and nutrition at the University of Minnesota, Minneapolis and colleagues wrote.
Researchers conducted a retrospective analysis within the MHealth Fairview System from March 1 to June 30, 2020, of 339 in-patients with acute pancreatitis. Seventy-five of these patients underwent PCR testing for SARS-CoV-2 during the index admission or within 14 days before hospitalization. Patients with positive PCR tests were compared with negative tests.
Investigators collected data on baseline characteristics, etiology of acute pancreatitis, Bedside Index of Severity in Acute Pancreatitis (BISAP) scores, clinical and radiological outcomes, length of stay (LOS), ICU admissions, requirement of mechanical ventilation and mortality. They also calculated a Charlson Comorbidity Index for each participant. Index admission mortality served at the primary outcome. Other outcomes included organ failure, multiorgan failure, persistent organ failure, LOS, ICU stay, need for mechanical ventilation and pancreatitis-related outcomes.
Fourteen of the 75 patients tested for SARS-CoV-2 were positive for COVID-19. Investigators found on presentation a higher CCI (P = .003) and BISAP score (P < .001) in patients with AP and COVID-19. They reported alcoholic AP as the main diagnosis in patients who tested negative for COVID-19 and idiopathic AP among those who tested positive for COVID-19 (P < .001). Patients with AP and coexisting COVID-19 had higher mortality (P = .004). These patients also had a significantly higher incidence of multiorgan failure (P < .0001) and persistent organ failure (P < .0001); however, the cohorts were not significantly different regarding the AP pattern, incidence of infected necrosis, splanchnic venous thrombosis or acute endocrine insufficiency.
“Whether the SARS-CoV-2 aggravated the ongoing inflammatory state of pancreatitis and resulted in worse outcomes is not certain, but plausible,” Dirweesh and colleagues wrote. “Of note, as AP was the primary admission diagnosis in the majority of the study population, the higher in-hospital mortality in patients with concomitant AP and COVID-19 is not simply explained by an overall sicker COVID-19 cohort.”
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