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Published on: February 16, 2022
Serum amylase elevation is associated with adverse clinical outcomes in patients with coronavirus disease 2019
Ganxun Li1, Tongtong Liu2, Guannan Jin3
1Hepatic Surgery Center, and Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, National Medical Center for Major Public Events, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Insights
Elevated serum amylase, or hyperamylasemia, is common in hospitalized COVID-19 patients and linked to worse outcomes. Monitoring amylase levels during hospitalization may help identify patients at risk for severe complications and death.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Hyperamylasemia has been observed in patients with coronavirus disease 2019 (COVID-19).
- The clinical significance and evolution of hyperamylasemia in COVID-19 patients remain poorly understood.
Purpose of the Study:
- To assess the prevalence and clinical significance of hyperamylasemia in COVID-19 patients.
- To identify factors associated with hyperamylasemia and its impact on clinical outcomes.
Main Methods:
- Retrospective cohort study of 1,515 COVID-19 patients with longitudinal amylase data.
- Analysis of epidemiological, demographic, laboratory, treatment, and outcome information.
- Multivariable logistic regression and restricted cubic spline analyses were employed.
Main Results:
- 12.9% of patients developed hyperamylasemia; 1.3% had levels >3x ULN without acute pancreatitis.
- Older age, male sex, chronic kidney disease, certain medications, and increased creatinine were associated with hyperamylasemia.
- Hyperamylasemia independently predicted in-hospital mortality and severe complications (sepsis, cardiac injury, ARDS, AKI).
Conclusions:
- Elevated serum amylase is an independent risk factor for adverse outcomes in COVID-19.
- Dynamic monitoring of serum amylase during hospitalization is recommended for early intervention and improved patient management.
Objective:
Hyperamylasemia was found in a group of patients with COVID-19 during hospitalization. However, the evolution and the clinical significance of hyperamylasemia in COVID-19, is not well characterized.
Design:
In this retrospective cohort study, the epidemiological, demographic, laboratory, treatment and outcome information of 1,515 COVID-19 patients with available longitudinal amylase records collected from electronic medical system were analyzed to assess the prevalence and clinical significance of hyperamylasemia in this infection. Associated variables with hyperamylasemia in COVID-19 were also analyzed.
Results:
Of 1,515 patients, 196 (12.9%) developed hyperamylasemia, among whom 19 (1.3%) greater than 3 times upper limit of normal (ULN) and no clinical acute pancreatitis was seen. Multivariable ordered logistic regression implied older age, male, chronic kidney disease, several medications (immunoglobin, systemic corticosteroids, and antifungals), increased creatinine might be associated with hyperamylasemia during hospitalization. Restricted cubic spline analysis indicated hyperamylasemia had a J-shaped association with all-cause mortality and the estimated hazard ratio per standard deviation was 2.85 (2.03-4.00) above ULN. Based on the multivariable mixed-effect cox or logistic regression model taking hospital sites as random effects, elevated serum amylase during hospitalization was identified as an independent risk factor associated with in-hospital death and intensive complications, including sepsis, cardiac injury, acute respiratory distress syndrome, and acute kidney injury.
Conclusions:
Elevated serum amylase was independently associated with adverse clinical outcomes in COVID-19 patients. Since early intervention might change the outcome, serum amylase should be monitored dynamically during hospitalization.
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