Hyperamylasemia in COVID-19 patients: pancreatic involvement or secondary epiphenomenon?

Elevated serum amylase has been frequently observed in COVID-19 patients, but whether hyperamylasemia results from a direct or indirect pancreatic effect or other mechanisms remains debated. Our study aimed to investigate the association between hyperamylasemia, pancreatitis, and COVID-19 severity. We retrospectively analyzed 1858 patients who visited the emergency department of Fondazione Policlinico Gemelli-IRCCS in Rome during the first two years of the pandemic. All had a confirmed COVID-19 diagnosis and underwent serum amylase evaluation. Clinical and laboratory data, including oxygen therapy requirements, intensive care unit (ICU) admission, and mortality, were extracted from electronic medical records. Univariate analysis revealed a correlation between hyperamylasemia and blood urea nitrogen, ICU admission, multiple comorbidities, and D-dimer levels. Multivariable logistic regression, adjusted for age, sex, comorbidities, and blood urea nitrogen, confirmed that ICU admission-but not in-hospital mortality-was independently associated with hyperamylasemia. Acute pancreatitis was diagnosed in only four patients. Elevated serum amylase levels appear more related to disease severity than direct pancreatic involvement. Emergency physicians should recognize that hyperamylasemia detected upon emergency department admission in COVID-19 patients may indicate an increased risk of ICU admission rather than acute pancreatitis, warranting closer evaluation and management.