COVID-19 rarely presents as acute pancreatitis

Last Updated: 2020-09-08

By Will Boggs MD

NEW YORK (Reuters Health) - COVID-19 presents as acute pancreatitis in fewer than 1% of patients hospitalized for the infection, according to a retrospective study.

"Greater attention should be paid to the history or complaint of abdominal pain, and obtaining serum lipase levels in these patients should be considered," Dr. Arvind J. Trindade of Long Island Jewish Medical Center and the Zucker School of Medicine at Hofstra/Northwell, in New Hyde Park, New York, told Reuters Health by email.

Several case reports have identified acute pancreatitis as the initial presentation in patients with COVID-19, but how often this presentation occurs remains unclear.

Dr. Trindade and colleagues evaluated the prevalence, risk factors and outcomes of hospitalized patients with COVID-19 presenting with acute pancreatitis at 12 hospitals within the Northwell Health System from March 1 to June 1.

Among the nearly 11,900 patients hospitalized with COVID-19, 32 had acute pancreatitis, yielding a point prevalence of 0.27%. This compared with an overall acute pancreatitis prevalence of 0.39% among the more than 48,000 patients hospitalized during this period.

Gallstones and alcohol use were the most common etiologies of acute pancreatitis among patients without COVID-19, whereas idiopathic pancreatitis was the most common etiology among patients with COVID-19.

Among patients with pancreatitis, Blacks and Hispanics had 4.48-fold and 5.07-fold greater odds, respectively, of having COVID-19, the researchers report in Gastroenterology.

"It is unclear why this association was seen, but more research needs to be conducted to help elucidate the pathophysiology behind this," Dr. Trindade said.

Patients with pancreatitis who were also SARS-CoV-2 RNA-positive had 5.65-fold higher odds of requiring mechanical ventilation and 3.22-fold higher odds of extended hospital stays, compared with patients with pancreatitis who tested negative for SARS-CoV-2.

Mortality rates and development of pancreatic necrosis tended to be higher among patients with COVID-19, but these differences were not statistically significant.

"The management of pancreatitis is still the same," Dr. Trindade said. "Patients should receive copious intravenous fluids, have nothing by mouth initially (with the goal of early refeeding if tolerated), and pain control."

He added, "A recent autopsy study published in Lancet Microbe helps support the findings of our study, in that on autopsy 22% of the patients in that series had pancreatitis."

SOURCE: https://bit.ly/2F2OlhZ Gastroenterology, online August 26, 2020.