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COVID-19 Infection Deteriorates the Clinical Condition and Outcomes of Acute Pancreatitis: A Meta-Analysis
Yulin Guo1, Shun Hu2, Xiaohui Wang1
1Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Insights
COVID-19 significantly increases the risk of severe acute pancreatitis (AP) complications, including pancreatic necrosis and organ failure. Patients with COVID-19 and AP face higher mortality rates and ICU admission.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has been linked to various organ injuries, including the pancreas.
- Acute pancreatitis (AP) is a known complication that can occur in patients with COVID-19.
- Understanding the impact of COVID-19 on AP severity and outcomes is crucial for patient management.
Purpose of the Study:
- To conduct a meta-analysis comparing the morbidity and outcomes of AP in COVID-19 positive versus negative patients.
- To assess the association between COVID-19 infection and the severity of AP.
- To evaluate the impact of COVID-19 on mortality and complications in AP patients.
Main Methods:
- Systematic literature search of Cochrane Library, PubMed, and EMBASE databases up to July 3rd, 2022.
- Inclusion of studies comparing AP severity and outcomes in COVID-19 positive and negative patients.
- Meta-analysis using mean differences and odds ratios with 95% confidence intervals; publication bias assessed via funnel plots.
Main Results:
- Seven studies involving 2816 AP patients were analyzed.
- COVID-19 positive patients showed higher incidences of pancreatic necrosis, persistent organ failure (cardiovascular, respiratory), and elevated CRP levels.
- COVID-19 infection was associated with increased coagulation disorders, higher ICU admission rates, and significantly higher mortality (OR=3.70).
Conclusions:
- COVID-19 infection appears to exacerbate the severity and clinical outcomes of acute pancreatitis.
- The findings indicate a substantial increase in morbidity and mortality for AP patients with concurrent COVID-19.
- Limitations include a small number of studies and lack of RCTs, necessitating caution regarding publication and selection bias.
Backgrounds:
The novel coronavirus disease 2019 (COVID-19) has caused a global pandemic. Pancreatic injuries have been reported in COVID-19 patients. The present meta-analysis was conducted to compare the morbidity and outcomes of AP between COVID-19 positive and negative patients.
Methods:
Databases including Cochrane Library, PubMed, and EMBASE were systematically searched (until July 3rd 2022). Studies with English abstracts comparing the severity and outcomes of AP between COVID-19 positive and negative patients were included. Mean differences or odds ratios with a 95% confidence interval were employed for assess variables. Risk of publication bias was assessed with funnel plots.
Results:
Data from 7 studies with a total of 2816 AP patients were included. COVID-19 positive was associated with higher incidences of pancreatic necrosis (OR = 1.65; 95% CI: 1.13 to 2.42, P = 0.01; P = 0.82 for heterogeneity) and persistent organ failure (OR = 6.87; 95% CI: 2.37 to 19.98, P = 0.0004; P = 0.12 for heterogeneity), especially cardiovascular failure (OR = 2.92; 95% CI: 1.66 to 5.14, P = 0.0002; P = 0.58 for heterogeneity) and acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) (OR = 3.03; 95% CI: 2.09 to 4.39, P < 0.00001; P = 0.20 for heterogeneity). COVID-19 infection induced a higher level of CRP (MD = 0.40; 95% CI: 0.16 to 0.64, P = 0.001; P < 0.00001 for heterogeneity) as well as coagulation disorders involving platelets, prothrombin time, activated partial thromboplastin time, and D-dimer (all P < 0.05). During hospitalization, COVID-19 positive was associated with higher ICU admission rate (OR = 2.76; 95% CI: 1.98 to 3.85 P < 0.00001; P = 0.47 for heterogeneity). COVID-19 positive AP was associated with a higher mortality rate (OR = 3.70; 95% CI: 2.60 to 5.25, P < 0.00001; P = 0.12 for heterogeneity). Discussion. The number of included studies is limited and none is RCT, thus the risks of publication and selective bias could not be ignored. COVID-19 deteriorated the severity and clinical outcomes of AP, with a high incidence of morbidity and mortality.
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