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Patients with acute pancreatitis and co-existent SARS-CoV-2 infection were at significantly increased risk of severe disease, organ failure, prolonged hospital stays, and a high 30-day mortality, a large international cohort study found.

Collaborators in the COVID PAN study led by Manu Nayar, MBBS, MD, of Freeman Hospital in Newcastle upon Tyne, England, reviewed 1,777 adult patients with acute pancreatitis during the period March 1 to July 23, 2020. Of these, 149 (8.3%) had concomitant SARS-CoV-2 infection.

In an unadjusted analysis, SARS-CoV-2-positive patients with acute pancreatitis were more likely to experience the following outcomes:

• Admission to the intensive care unit: odds ratio (OR) 5.21 (P<0.001)
• Local complications: OR 2.91 (P<0.001)
• Persistent organ failure: OR 7.32 (P<0.001)
• Prolonged hospital stay: OR 1.89 (P<0.001)
• Higher than usually reported 30-day mortality at 14.7%: OR 6.56 (P<0.001)

The increased mortality, the authors wrote online in , was most likely due to older age, worse performance status scores, and more severe disease and complications in positive patients.

In an adjusted analysis, length of hospital stay (OR 1.32, P<0.001), persistent organ failure (OR 2.77, P<0.003), and 30-day mortality (OR 2.41, P<0.04) were significantly higher in co-infected patients.

"If the infection continues to be prevalent without an effective treatment or vaccine, these data help clinicians to better prognosticate for patients with concomitant AP [acute pancreatitis] and SARS-CoV-2 infection and optimize resource allocation," Nayar and team noted.

Emerging data suggest the pancreas is a target organ of SARS-CoV-2 because the angiotensin-converting enzyme receptor is expressed in pancreatic acinar and islet cells.

In other study findings:

• Acute pancreatitis was significantly more severe in SARS-CoV-2-positive patients, with 22.6% of infected patients developing severe acute pancreatitis versus 6.3% of uninfected patients (P<0.001).
• The development of acute respiratory distress syndrome was also significantly more likely in the positive (13.6%) versus negative group (4%; P<0.001).
• Positive patients were more likely to undergo necrosectomy (5% vs 1%; P<0.001).
• Conversely, an index cholecystectomy was less frequent in positive patients (P<0.02).

The cohort was drawn from a multicenter database with contributing centers from England, Wales, Scotland, Northern Ireland, Malta, Italy, Pakistan, Turkey, and Lithuania.

Overall, SARS-CoV-2-positive patients with acute pancreatitis tended to be older men with a greater likelihood of developing severe acute pancreatitis and acute respiratory distress syndrome (P<0.001). The mean ages were 59.9 for positive patients and 54.5 for negative patients, with men accounting for 62.8% and 51.5% of the two groups, respectively.

The number of patients with an alcohol etiology was significantly higher in the negative group (26.7% vs 18.8%; P=0.04), while acute pancreatitis of unknown etiology was more common in the positive group (24.8% vs 19.4%), but this difference was not statistically significant (P=0.08).

Eastern Cooperative Oncology Group performance status scores were significantly worse in positive patients, with 15.2% having a score of 3 or 4 compared with 4.1% of negative patients (P<0.001). There were no significant differences in liver steatosis or body mass index between groups, nor was there a significant difference in ethnicity.

Asked for his perspective, Arvind Trindade, MD, of Northwell Health System's Feinstein Institutes for Medical Research in Manhasset, New York, who was not involved in the COVID PAN study, said the findings augment our understanding of outcomes in patients with COVID-19 who develop pancreatitis. They are similar to results from a 2020 study conducted by Trindade and colleagues, and to research from the .

"The U.S. studies suggest SARS-CoV-2 itself is an etiology for pancreatitis -- a statistically higher rate of COVID-19 patients had idiopathic pancreatitis compared with patients without COVID-19," he said. This was not seen in the COVID PAN study, although there was a trend toward it.

"These studies show the importance of diagnosing pancreatitis in COVID-19 patients early, so aggressive therapy can be started," Trindade added.

The authors acknowledged several limitations to the study, including different testing protocols across participating centers and the necessity of diagnosing COVID-19 by symptoms and CT criteria before routine laboratory tests were available.

In addition, the poor sensitivity of testing during the early phase of the pandemic means there may be a small fraction of patients who were presumed negative for SARS-CoV-2 infection included in the group of patients with acute pancreatitis with no SARS-CoV-2 infection.

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