Sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated pancreatitis may represent a distinct phenotype of pancreatitis characterized by metabolic stress, abdominal pain, and specific patterns of inflammation, according to results from a case series study published in Gastroenterology.
Researchers sought to assess features of pancreatic injury in patients with coronavirus disease 2019 (COVID-19). Patients with pancreatitis and confirmed SARS-CoV-2 infection who received treatment at the Royal Liverpool Hospital in England were eligible for inclusion. Cases with pre-existing pancreatic pathology or etiology which was unrelated to SARS-CoV-2 were excluded. The researchers extracted clinical and radiology data from medical records. Contrast-enhanced computerized tomography (CECT) imaging results were reported by an expert pancreatic radiologist.
Between March 14 and April 30, 2020, 35 patients with acute pancreatitis received care at the Royal Liverpool University Hospital. Of these, 10 patients tested positive for SARS-CoV-2. In total, 5 of these 10 presented with a clearly defined etiology for pancreatitis and were excluded from analyses. The remaining 5 presented homogenously with an atypical form of pancreatitis. All patients were young adult men (median age, 42 years; interquartile range [IQR], 15) who were either overweight or obese (median body mass index [BMI], 30; IQR, 16.7).
Pancreatitis was diagnosed by CECT in all patients, as serum amylase was elevated but non-diagnostic (median, 149 U/L; IQR, 328). Metabolic distress was evident in all patients on admission; median triglycerides and glucose levels were 2.7 (18.2) and 10 (8.6) mmol/L, respectively. CECT showed transient moderate to severe hepatic steatosis (<104 Hounsfield Units [HU]) in all patients, which rapidly regressed during follow-up. Median attenuation upon admission was -3.5 (55.8) HU, which improved to 31.12 (3.1) HU after 7 days of inpatient care. The pattern of pancreatic inflammation was similarly unusual in all patients, described by investigators as “mild pancreatic edema without significant…necrosis, with distinct duodenal/periduodenal inflammation involving the second and third part of the duodenum.”
Systemic inflammation and C-reactive protein elevation were present in all 5 patients at admission. Patients were treated with intravenous fluids, and opiate analgesia was provided to manage abdominal pain. In addition, 4 of 5 patients received broad-spectrum intravenous antibiotics for the treatment of pneumonitis. No patients received corticosteroids, and none required organ support beyond oxygen therapy. Median length of hospital stay was 14 days (range, 6-16 days).
Results from this case series analysis suggest that SARS-CoV-2-related pancreatitis may represent a distinct phenotype, defined by male sex, abdominal pain, metabolic stress, and pancreatico-duodenal inflammation with steatosis on CT. However, causality cannot be established from a cross-sectional analysis. Further analysis of pancreatitis with SARS-CoV-2 infection is necessary to fully assess the gastrointestinal risks of COVID-19.
Szatmary P, Arora A, Raraty MGT, Dunne DFJ, Baron RD, Halloran CM. Emerging phenotype of SARS-CoV2 associated pancreatitis [published online May 27, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.05.069
This article originally appeared on Gastroenterology Advisor