COVID-19-Induced Acute Pancreatitis: Clinical Profiles, Outcomes, and Prognostic Indicators From a Global Review-Based Synthesis.

Abstract

<h4>Background and aims</h4>During the coronavirus disease 2019 (COVID-19) pandemic, acute pancreatitis (AP) in patients with COVID-19 has attracted considerable attention. While many reports have described "concurrent COVID-19 and AP" without excluding established etiologies, the concept of "COVID-19-induced AP" remains less clearly defined. This study aimed to investigate the associations between initial clinical presentations and outcomes in COVID-19-induced AP, offering real-world evidence to identify predictors of short-term prognosis.<h4>Methods</h4>This is a review-based synthesis for human studies, with literature search (October 2019-March 2022) using PubMed dual strategies, "Medical Subject Headings (MeSH)" and "title/abstract." COVID-19-induced AP was defined by the exclusion of other established etiologies for pancreatitis.<h4>Results</h4>We identified 111 patients (median age 39 years) with 11 deaths. Gastrointestinal symptoms preceded admission in 30.6% of cases, while respiratory symptoms preceded admission in 52.3%. Pancreatitis symptoms before admission were associated with younger age, less lymphocyte counts, lower neutrophil-to-lymphocyte ratio, and higher radiologic severity (Balthazar score). Initial white blood cell (WBC) count ≥ 14,000/µL and pancreatic necrosis correlated with surgical intervention. Kaplan-Meier analysis demonstrated that overall survival was not influenced by the sequence of gastrointestinal and respiratory symptom onset (concurrent vs. successive; <i>p</i> = 0.543) or by whether pancreatitis symptoms developed before or after hospital admission (<i>p</i> = 0.228). Multivariate Cox regression identified elevated WBC count (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.000-1.025; <i>p</i> = 0.042), AST-to-ALT ratio ≥ 2 (HR: 11.052; 95% CI: 1.441-84.770; <i>p</i> = 0.021), and surgical intervention (HR: 6.604; 95% CI: 1.581-27.593; <i>p</i> = 0.010) as independent mortality predictors.<h4>Conclusion</h4>Unlike "concurrent COVID-19 and AP (without excluding established AP etiologies)," "COVID-19-induced AP" showed no survival disparity by symptom chronology. Mortality was linked to leukocytosis, AST-to-ALT ratio, and surgical intervention. Standardized terminology distinguishing "COVID-19-induced AP" from "concurrent COVID-19 and AP" is essential to ensure comparability of global clinical data and reduce interpretive bias.