Marked Elevation of Lipase in COVID-19 Disease: A Cohort Study

Abstract

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes. METHODS: Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t -test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension. RESULTS: Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis ( P < 0.001) and abnormal liver enzymes ( P < 0.01). Compared with lower lipase levels (<3 × ULN), patients with elevated lipase had higher rates of ICU admission (92.9% vs 32.8%; P < 0.001) and intubation (78.6% vs 23.5%; P 0.002). In a multivariable-adjusted model, higher lipase levels were significantly associated with admission to the ICU and rate of intubation. DISCUSSION: Lipase elevation is seen in COVID-19 and is associated with worse disease outcomes.

Coronavirus disease 2019 and the pancreas

“…[ 36 ] (China) 9/52 (17.3%) 7/52 (13.5%) 5/52 (9.6%) None .. 4/9 (44.4%) 7/9 patients - corticosteroids; No definite clinical AP Barlass et al . [ 37 ] (USA) 14/83 (16.8%) .. 14/83 (16.8%) None .. 13/14 (92.9%) Elevated lipase associated with increased ICU admission and intubation COVID-19 Coronavirus disease 2019; CT Computed tomography; NSAIDs Non-steroidal anti-inflammatory drugs; GI Gastrointestinal; ULN Upper limit of normal; AP Acute pancreatitis; ICU Intensive care unit. …”

“…Laboratory abnormalities suggestive of pancreatic injury have been noted in 8.5%–17.3% of cases [ 15 , [34] , [35] , [36] , [37] ] in various studies. Overall 51 (12.8%) of the 397 reported patients had pancreatic injury.…”

“…Barlass et al. [ 37 ], on multivariate analysis, showed that elevated lipase level was associated with a significantly increased need for ICU admission and intubation. Additionally, most of the studies have found that a majority of patients with reported pancreatic abnormalities had GI symptoms such as nausea, anorexia, abdominal discomfort (not pain) and diarrhea [ [34] , [35] , [36] ].…”

Increased serum amylase and/or lipase in coronavirus disease 2019 (COVID‐19) patients: Is it really pancreatic injury?

“…Barlass et al 10 . from Chicago, USA, studied 294 admitted COVID‐19 patients, and 83 of them were checked for serum lipase.…”

“…Novel insights were provided by Barlass et al 10 . They studied the serum lipase level and found that elevated serum lipase level was significantly related to the rate of ICU admission and intubation.…”