Acute pancreatitis and COVID-19: A literature review

Abstract

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19), and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARS-CoV-2, but the mechanisms of pancreatic injury are still a subject of debate. There is also controversy on whether SARS-CoV-2 can cause AP or if it is an epiphenomenon. AIM To review and to explore the relationship between SARS-CoV-2 infection and AP, and to provide an overview of the existing literature on possible mechanisms of SARS-CoV-2-induced pancreatic lesion. METHODS A systematic review was conducted in accordance with PRISMA guidelines for papers on SARS-CoV-2 infection and AP. A narrative review on possible mechanisms of SARS-CoV-2-induced pancreatic lesion was also performed. RESULTS A literature review revealed a growing body of evidence on SARS-CoV-2-induced pancreatic lesions including the mechanisms of direct virus-mediated injury, systemic inflammatory response and circulating pro-inflammatory interleukins, virus-induced lipotoxicity, and drug-induced injury. A systematic review of the literature revealed 22 cases of AP in COVID-19 patients. However, limitations of the reported cases make it difficult to establish a causal relationship between SARS-CoV-2 infection and AP. All of the studies agreed on special monitoring and surveillance of this subset of patients due to the still unknown clinical progression, therapeutic implications, and prognosis. CONCLUSION AP should be considered in COVID-19 patients, especially in those exhibiting abdominal pain and systematic, and complete reporting of these cases should be general practice. However, there is still insufficient evidence showing that COVID-19 can cause AP or negatively impact prognosis. Additional studies are needed to clarify the relationship between these two entities and their theragnostic significance.

Coronavirus disease 2019 (COVID 19) induced acute necrotizing pancreatitis in a female child: A case report

“…A study done by Fan Wang has shown that nine out of 52 patients with COVID 19 infection have pancreatic injury [ 5 ]. Furthermore, approximately 10% of the COVID 19 positive patients may present only with gastrointestinal symptoms [ 6 ].…”

Insights into Acute Pancreatitis Associated COVID-19: Literature Review

“…Interestingly, recent literature reviews in Correia de Sá T et al [25] and Jabło ńska B et al [26]-where they used a different search approach and included case reports/seriesconcluded that there is still insufficient evidence demonstrating that COVID-19 can cause AP or negatively impact disease prognosis. Ultimately, the most important clinical research questions are how to predict the course of the disease and the overall outcome when COVID-19 and AP coexist.…”

Combined Hyperglycemic Hyperosmolar Syndrome and Diabetic Ketoacidosis Associated with COVID-19 in a Pediatric Patient

“…Furthermore, COVID-19 is also associated with acute pancreatitis. Although the clear pathogenesis is still unknown, it is thought to be from the direct cytotoxic effect of the virus on the exocrine pancreas, secondary to cytokine storm, or damage from microvascular thrombosis [ 24 – 26 ].…”