Pancreatic Injury in Severe SARS-CoV-2 Infection: A Retrospective Study Across Three Pandemic Waves

Acute pancreatitis (AP) has emerged as a notable complication in patients with COVID-19, yet the interplay between viral infection, systemic inflammation, and pancreatic injury remains incompletely understood. This study aimed to evaluatethe characteristics and risk factors of APin patients with severe COVID-19 pneumonia. We conducted a retrospective, single-center analysis of 405 hospitalized COVID-19 patients with and without AP. Laboratory markers, including CRP, ESR, fibrinogen, LDH, D-dimers, WBC, neutrophils, serum potassium, and serum glucose, alongside imaging and clinical parameters, were analyzed for associations with AP occurrence. Our results indicate that elevated inflammatory and coagulation markers, leukocytosis with neutrophilia, hyperglycemia, hypokalemia, and more severe pulmonary involvement were significantly associated with AP in COVID-19. LDH and inflammatory markers demonstrated particularly strong predictive value, while D-dimers and lung injury severity also contributed to risk stratification. These findings suggest that systemic inflammation, endothelial dysfunction, immunothrombosis, and metabolic impairments converge to increase pancreatic vulnerability in COVID-19 patients. Early recognition of these risk factors may guide monitoring and therapeutic interventions, although prospective validation is needed.