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

Abstract

Objectives

To review clinical and laboratory findings in patients with SARS-Cov-2 (COVID-19) related acute pancreatitis.

Methods

This systematic review was based on a database search for articles of COVID-19 related acute pancreatitis in adult patients with confirmed COVID-19 infection that included age, gender, presenting symptoms, the onset of symptoms, laboratory values, imaging findings and exclusion of common causes of pancreatitis.

Results

Altogether 35 articles comprising 37 patients were included. Acute pancreatitis was the first presentation of COVID-19 in 43% of patients, concurrent with general or respiratory symptoms in 14% of patients or delayed after general or pulmonary symptoms by an average of 10 ± 5 d (range, 1 − 19 d) in 43% of patients. Serum amylase and lipase levels were elevated in 87% and 100% of patients. In 50% and 84%, amylase and lipase levels exceeded three-fold the upper normal limit. Pancreatic necrosis was reported in 6% of patients and in 12% of patients, the pancreas appeared normal. Three patients died.

Conclusions

We conclude that the bi-modal pattern of the onset of symptoms supports both the cytotoxic and the immune-related pathogenesis of the pancreatic injury. Acute pancreatitis may be the first symptom of COVID-19 infection. Necrosis of the pancreas is rare.

Keywords:

• COVID-19
• SARS-Cov-2
• pancreatitis
• lipase
• computed tomography

Disclosure statement

The authors declare that they have no conflict of interest regarding the publication of this work.

Additional information

Funding

This study was supported by the Ministry of Health of the Czech Republic [General University Hospital in Prague – VFN, 00064165] and the Charles University in Prague [Progres Q28/LF1, UNCE 204065].