SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study
Sanjay Pandanaboyana, John Moir, John Leeds, Kofi Oppong, Aditya Kanwar, Ahmed Marzouk, Ajay Belgaumkar, Ajay Gupta, Ajith K. Siriwardena, Ali Haque, Altaf Awan, Anita Balakrishnan, Arab Rawashdeh, B. Ivanov, Chetan Parmar, Christopher Halloran, Clifford Caruana, Cynthia-Michelle Borg, Dhanny Gomez, Dimitrios Damaskos, Dimitrios Karavias, Guy Finch, Husam Ebied, James Pine, James Skipworth, James Milburn, Javed Latif, Jeyakumar Apollos, Jihène El Kafsi, John A. Windsor, Keith Roberts, Kelvin Wang, Krish Ravi, Maria Coats, Marianne Hollyman, Mary Phillips, Michael Okocha, Michael Wilson, Nadeem A Ameer, Nagappan Kumar, Nehal Shah, Pierfrancesco Lapolla, Connor Magee, Bilal Al‐Sarireh, R Lunevicius, Rami Benhmida, Rishi Singhal, Srinivasan Balachandra, Semra Demirli Atıcı, Shameen Jaunoo, Simon Dwerryhouse, Tamsin Boyce, Vasileios Charalampakis, Venkat Kanakala, Zaigham Abbas, Manu Nayar
Abstract
OBJECTIVE: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.