An increase in pancreatic enzymes was associated with progression to severe disease and poor outcomes among patients with COVID-19 infection, according to results of a study published in Pancreatology.
Researchers conducted a systematic review and meta-analysis to evaluate the prevalence and effect of increased pancreatic enzymes in patients with COVID-19 infection. An increase in pancreatic enzymes was defined as an increase in amylase and/or lipase concentrations above the upper limit of normal (ULN). The researchers also assessed the prevalence of patients with pancreatic enzymes that were increased more than 3 times the ULM.
A total of 21 studies representing 36,496 patients were included in the final analysis. The researchers found that the estimated overall pooled prevalence of patients with increased pancreatic enzymes was 25.4% (95% CI, 15.8-36.2), with acute pancreatitis diagnosed in only 1.7% of patients. Subgroup analyses also were performed among hospitalized patients and those who required intensive care unit (ICU) admission. Results showed that the pooled prevalence of increased pancreatic enzymes was decreased among hospitalized patients (>ULM, 19.4%; 95% CI, 10.9-29.5; >3 times ULM, 4.7%; 95% CI, 2.4-7.5) compared with ICU patients (>ULM, 63.9%; 95% CI, 57.0-76.6; >3 times ULM, 24.5%; 95% CI, 16.6-33.3).
Further analysis showed that the overall pooled mortality associated with increased pancreatic enzymes that were more than the ULM and more than 3 times the ULM was 34.6% (95% CI, 25.5-44.4) and 39.2% (95% CI, 18.7-61.6), respectively. In subgroup analyses, the pooled mortality associated with increased pancreatic enzymes was decreased among hospitalized patients (>ULM, 31.1%; 95% CI, 21.5-41.4) compared with those admitted to the ICU (>ULM, 56.2%; 95% CI, 15.5-92.5).
Patients with increased pancreatic enzymes were statistically significantly more likely to have hypertension (odds ratio [OR], 1.27; 95% CI, 1.05-1.53), diabetes (OR, 1.48; 95% CI, 1.10-2.00), require ICU admission (OR, 3.90; 95% CI, 2.59-5.87), and require mechanical ventilation (OR, 2.90; 95% CI, 2.03-4.14). Patients with increased concentrations of only lipase also were statistically significantly more likely to have hypertension (OR, 1.26; 95% CI, 1.01-1.58), require ICU admission (OR, 3.30; 95% CI, 2.30-4.72), and require mechanical ventilation (OR, 2.24; 95% CI, 1.81-2.77).
Limitations included small sample sizes, heterogeneity, and the lack of uniform patient populations and control groups among the studies included in the analysis. In addition, most studies had a retrospective design, and confounding factors and the lack of multivariable analyses may have limited the ability to assess the real effect of increased pancreatic enzymes on outcomes of COVID-19 infection.
The researchers concluded that “…serum lipase could prove to be helpful in monitoring [patients with] COVID-19 [infection] and predicting outcomes as it has higher specificity.”
Yang F, Xu Y, Dong Y, et al. Prevalence and prognosis of increased pancreatic enzymes in patients with COVID-19: a systematic review and meta-analysis. Pancreatology. Published online March 16, 2022. doi:10.1016/j.pan.2022.03.014