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Viral-Attributed Acute Pancreatitis: A Systematic Review
C Roberto Simons-Linares1, Zaid Imam2, Prabhleen Chahal3
1Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. robertosimons@outlook.com.
Abstract:
Infectious etiologies are rare cause of acute pancreatitis (AP). We sought to investigate the frequency of viral-attributed AP (VIAP) and describe its natural course and clinical features. Comprehensive review of PubMed and EMBASE in English until December 31, 2019, was performed. AP diagnosis and severity were defined per the Revised Atlanta Classification. Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities, and the attempt to exclude the most common etiologies of AP defined VIAP. Two independent reviewers reviewed eligible publications. Bias risk was assessed with the Murad tool. A total of 209 cases identified in 128 publications met inclusion criteria. Mean age was 38.9 ± 1.28 years. Male-to-female ratio was 2.2:1, and 28% of patients were immunocompromised. Viral hepatitis (A, B, C, D and E) was the most common virus and accounted for 34.4% of cases, followed by coxsackie and echoviruses (14.8%), hemorrhagic fever viruses (12.4%), CMV (12.0%), VZV (10.5%), mumps and measles (3.8%), primary HIV infection (3.8%), HSV (1.9%), EBV (1.9%), and the remainder of cases (2.9%) attributed to adenovirus, influenza H1N1, and multiple viruses. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death occurred in 42 (20.1%) patients. A significant portion of VIAP patients were immunocompromised (28.0%) and accounted for 71.4% of mortality cases. Mortality was higher than that reported for AP from other etiologies in the literature.
Insights
Viral-attributed acute pancreatitis (VIAP) is rare but serious, especially in immunocompromised patients. This review found VIAP has a high mortality rate, exceeding that of other pancreatitis causes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Virology
Background:
- Infectious etiologies are uncommon causes of acute pancreatitis (AP).
- Viral-attributed acute pancreatitis (VIAP) requires further investigation into its frequency and clinical characteristics.
Purpose of the Study:
- To determine the incidence of VIAP.
- To describe the clinical course and features of VIAP.
Main Methods:
- A comprehensive literature review of PubMed and EMBASE (until December 31, 2019) was conducted.
- AP diagnosis and severity were defined using the Revised Atlanta Classification.
- Viral infections were confirmed via serology and/or histology, with VIAP diagnosis requiring concurrent AP and viral infection, temporal resolution, and exclusion of common AP etiologies.
Main Results:
- A total of 209 VIAP cases were identified across 128 publications.
- Viral hepatitis (A-E) was the most frequent cause (34.4%), followed by coxsackie/echoviruses (14.8%) and hemorrhagic fever viruses (12.4%).
- 28% of patients were immunocompromised, accounting for 71.4% of the 20.1% mortality rate, which was higher than other AP etiologies.
Conclusions:
- VIAP is a significant cause of acute pancreatitis with a high mortality rate.
- Immunocompromised status is a critical risk factor for mortality in VIAP.
- Further research is needed to understand and manage VIAP effectively.
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