P1053 - COVID-19-Related Pancreatitis: Clinical Spectrum From a Single Center

Swarup Kumar Patnaik, MD¹, Saroj Kanta Sahu, MD, DM², Ayaskanta Singh, MD, DM^3
1Siksha O. Anushandan Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Orissa, India; ²Sum Ultimate Medicare, Bhubaneswar, Orissa, India; ³Siksha O. Anusandhan Institute of Medical Sciences & SUM Hospital, Bhubaneshwar, Orissa, India

Introduction: Real-world data of severity and outcome of COVID-19 related acute pancreatitis (AP) is scarce. The study compares the severity and effects of COVID-19 related pancreatitis to other common forms of pancreatitis.

Methods: A retrospective analysis of 27 patients with AP, admitted to the Gastroenterology Unit of our institution (from October 2020 to March 2021). Relevant data were extracted from electronic health records. Cases of acute pancreatitis (AP) were classified as per the Revised Atlanta classification of AP. An AP episode was considered COVID-19, when other common causes of pancreatitis were ruled out. There is no worsening of pancreatitis after reintroducing medication that can cause pancreatitis (remdesivir, steroid etc.). All of the patients had no history of COVID-19 disease within 6 months before the diagnosis of AP. RT-PCR positivity for COVID 19 disease was mandatory to be considered COVID-19 related AP.

Results: The male to female ratio was 2.3 (19:8). COVID-19 related AP was the third most common cause of AP, alcohol being the commonest aetiology of AP [table 1]. Severe acute pancreatitis (SAP) was observed in a quarter (7/27) of patients. Alcohol-induced, biliary, and idiopathic AP cases contributed to the SAP patients. Patients with COVID-19 related acute pancreatitis (AP) have either mild or moderately severe AP. All patients with COVID-19 related pancreatitis had evidence of pneumonia on HRCT with a median CT severity score of 11. In these patients, the duration of hospitalization was more affected by pneumonia than AP itself (based on symptom-relief and toleration of diet). Among AP patients, the mortality rate at 2 weeks was 11.1% (2 had ANP, and 1 had COVID 19 pneumonia and sepsis) and at 4 weeks was 18.5% (5/27). One (20%) patient with COVID-19 related AP required ICU due to worsening of pneumonia and died during ICU stay.

Discussion: In the era of COVID-19 disease, alcohol and biliary AP remains the most common causes of AP. None of the COVID-19 related cases suffered from severe AP, including necrotizing pancreatitis. Also the duration of hospitalization and mortality was dictated by pulmonary-related events (pneumonia and secondary infection) more than AP itself. Further study in a larger cohort may strengthen these findings.

	Alcohol-induced	Biliary	COVID-19 disease	Hypertriglyceridemia	Unknown causes including idiopathic
% of total cases	11 (40.7%)	7 (25.9%)	5 (18.5%)	2 (7.4%)	4 (7.5 %)
Median duration of hospitalization (days)	9 (range 4 to 21)	6 (range 3 to 17 days)	12 days (range 6 to 15)	7 days (range 6 to 8 days)	5 days (range 3 to 8 days)
% of cases with severe acute pancreatitis	3/11 (27.2%)	2/7 (28.5%)	1	Nil	2/4 (50%)
% of cases with acute necrotizing pancreatitis	2/11 (18.1%)	1/7 (14.2%)			1/4 (25%)
Mortality at 2 weeks post hospitalization	1	Nil	1	Nil	1
Mortality at 4 weeks post hospitalization	2 (including 1 at 2 weeks)	1	1 (including 1 at 2 weeks)	N/A	N/A

Table: Table 1: Etiology, severity and outcome of patients with acute pancreatitis (n=27)


Disclosures:
Swarup Kumar Patnaik indicated no relevant financial relationships.
Saroj Kanta Sahu indicated no relevant financial relationships.
Ayaskanta Singh indicated no relevant financial relationships.


Swarup Kumar Patnaik, MD¹, Saroj Kanta Sahu, MD, DM², Ayaskanta Singh, MD, DM³. P1053 - COVID-19-Related Pancreatitis: Clinical Spectrum From a Single Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.