Association between Acute Pancreatitis and COVID-19: Could Pancreatitis Be the Missing Piece of the Puzzle About Increased Mortality Rates?

Background: The COVID-19 pandemic caused by SARS-CoV-2 commenced in Wuhan China in 2019 and soon spread worldwide. It is a viral disease that involves many organs and progresses with high mortality. SARS-CoV-2 enters the cell by binding to the ACE II receptor and begins viral replication. A serious immune response occurs where it settles leading to to tissue damage. The effects and clinical findings of SARS-CoV-2 on the liver, kidney, heart, gastrointestinal (GI) system and especially lungs have been widely discussed. However, the effects on the pancreas—another organ that also expresses ACE II—have not been studied. Methods: This work prospectively evaluated data from 316 patients who were admitted with a diagnosis of COVID-19 pneumonia. The patients were categorized into three according to the severity of pneumonia (mild, severe, critical). Demographic data, rate of pancreatitis, biochemical parameters, and radiological images from each group were analyzed. The patients were divided into two groups and outcomes were compared: COVID-19 patients with acute pancreatitis (Group P) and without acute pancreatitis (Group C). Findings: 12·6% of the patients had acute pancreatitis. While pancreatitis was not seen in patients on mild status, the rate of pancreatitis was 32·5% in critical patients. Hospitalization and mortality rates were higher in patients with COVID-19 accompanied by acute pancreatitis (p = 0·0038 and p <0·0001, respectively). Interpretation: Acute pancreatitis alone is a clinical condition that can lead to mortality and may be one of the reasons for the exaggerated immune response developing in the progression of COVID-19. In this study, the effects of pancreatic damage related to acute pancreatitis were investigated in terms of morbidity and mortality in COVID-19 patients.Funding Statement: This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: This study was carried out in accordance with the 1964 Helsinki Declaration and its recent amendments. Consents were obtained from conscious patients and from first degree relatives in unconscious patients. Permission was obtained from the local ethics committee (Ref. Nr:2020/148) and the Ministry of Health Scientific Research Institution (Ref. Nr:2020-05-04T_11_33_11).