SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pancreatic damage, both directly to the pancreas via angiotensin-converting enzyme 2 receptors (the transmembrane proteins required for SARS-CoV-2 entry, which are highly expressed by pancreatic cells) and indirectly through locoregional vasculitis and thrombosis. Despite that, there is no clear evidence that SARS-CoV-2 is an etiological agent of acute pancreatitis. Acute pancreatitis in coronavirus disease 2019 (COVID-19) positive patients often recognizes biliary or alcoholic etiology. The prevalence of acute pancreatitis in COVID-19 positive patients is not exactly known. However, COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative patients. Acute respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute pancreatitis. In this article, we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

Keywords: Acute pancreatitis; SARS-CoV-2; Severe acute pancreatitis; Multiparametric scores; Infected necrosis; Step-up approach

Core Tip: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing a severe acute respiratory syndrome, has rapidly spread from China all over the world, affecting millions of people. Whereas typical presentations of this infection (such as fever, cough, myalgia, fatigue and pneumonia) are well recognized, several studies report a low incidence of gastrointestinal symptoms. The relationship between SARS-CoV-2 infection and acute pancreatitis is controversial. Acute pancreatitis is not specifically caused by SARS-CoV-2. Furthermore, coronavirus disease 2019 positive patients are more likely to develop severe acute pancreatitis and multiple organ failure.