Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Table 1 Modified Naranjo Score used to grade the included studies with respective points allocated to each criterion

Criteria	Yes	No	Unsure
Are there published reports of the COVID-19 causing acute pancreatitis?	+ 1	0	0
Was there short latency (≤ 7 d) between the onset of infection and the diagnosis of acute pancreatitis?	+ 2	- 1	0
Was there a temporal relationship (≤ 1 mo) between onset of infection and onset of acute pancreatitis symptoms?	+ 1	- 1	0
Did the acute pancreatitis resolve following resolution of the infection?	+ 1	- 1	0
Were all commonly known causes of acute pancreatitis ruled out? (e.g., gallstones/choledocholithiasis, alcohol, hypertriglyceridaemia, hypercalcaemia, ERCP, trauma)	+ 1	- 1	0
Was a serum IgG4 level checked? (To rule out autoimmune pancreatitis)	+ 1	0	0
Does the patient have or was the patient recently diagnosed with an infection (other than COVID-19) which could cause pancreatitis?	- 1	+ 1	0
Was an EUS and/or MRCP performed? (e.g., to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum)	+ 1	- 1	0

COVID-19: Coronavirus disease 2019; IgG4: Immunoglobulin G4; ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography.

Table 2 Summary of all the included case reports (n = 76 patients) with respective patient demographics, modified Naranjo Score and interpretation

No	First author	Year	Patient age/Sex	Scoring								Summed score	Result1
1	Acherjya et al[16]	2020	57/F	1	2	1	1	1	0	1	- 1	6	Possible
2	Al-Douri et al[17]	2020	45/F	1	2	1	0	1	0	1	- 1	5	Possible
3	Al-Harmi et al[18]	2021	52/F	1	0	1	0	1	0	1	- 1	3	Doubtful
4	Ali et al[19]	2021	53/M	1	0	1	0	- 1	0	1	- 1	1	Doubtful
5	Aloysius et al[20]	2020	36/F	1	2	1	1	1	0	1	- 1	6	Possible
6	Alves et al[21]	2020	56/F	1	2	1	1	1	0	1	1	8	Probable
7	Alwaeli et al[22]	2020	30/M	1	2	1	0	1	0	1	- 1	5	Possible
8	Amé and Balderramo[23]	2022	42/F	1	2	1	0	1	0	1	- 1	5	Possible
9			65/F	1	0	1	0	1	1	1	1	6	Possible
10	Anand et al[24]	2020	59/F	1	0	1	0	1	0	1	- 1	3	Doubtful
11	Arjun et al[25]	2020	34/M	1	2	1	1	1	1	1	- 1	7	Probable
12	Bains et al[26]	2020	68/M	1	2	1	0	- 1	0	1	1	5	Possible
13	Bokhari and Mahmood[27]	2020	32/M	1	2	1	0	1	0	1	- 1	5	Possible
14	Bouali et al[28]	2021	60/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
15	Brikman et al[29]	2020	61/M	1	0	1	0	1	0	1	- 1	3	Doubtful
16	Canastar et al[30]	2020	64/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
17	Chandra et al[31]	2021	53/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
18	Cheung et al[32]	2020	38/M	1	2	1	0	1	1	1	1	8	Probable
19	Chivato et al[33]	2021	55/M	1	2	1	1	1	0	1	1	8	Probable
20	Dufani et al[34]	2020	27/F	1	2	1	0	1	0	1	- 1	5	Possible
21	Elhence et al[35]	2020	31/F	1	0	1	0	- 1	0	1	- 1	1	Doubtful
22			40/M	1	0	1	0	- 1	0	1	- 1	1	Doubtful
23			42/M	1	0	1	0	- 1	0	1	- 1	1	Doubtful
24	Fernandes et al[36]	2020	36/F	1	2	1	1	1	0	1	- 1	6	Possible
25	Fiore et al[37]	2021	42/M	1	2	1	0	1	0	1	- 1	5	Possible
26			70/M	1	0	1	0	1	0	1	- 1	3	Doubtful
27	Gadiparthi et al[38]	2020	40/M	1	2	1	1	- 1	0	1	- 1	4	Possible
28	Gadiparthi et al[39]	2021	74/F	1	2	1	0	1	0	1	- 1	5	Possible
29	Gonzalo-Voltas et al[40]	2020	76/F	1	2	1	1	1	0	1	- 1	6	Possible
30	Gupta et al[41]	2021	25/F	1	2	1	1	1	0	1	-1	6	Possible
31	Hadi et al[42]	2020	47/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
32			68/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
33	Hanif et al[43]	2021	30/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
34	Hassani et al[44]	2020	78/F	1	2	1	0	1	0	1	- 1	5	Possible
35	Ibrahim et al[45]	2020	33/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
36	Jespersen Nizamic et al[46]	2020	49/W	1	0	1	0	1	0	1	- 1	3	Doubtful
37	Kandasamy[47]	2020	45/F	1	2	1	1	1	0	1	- 1	6	Possible
38	Karimzadeh et al[48]	2020	65/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
39	Kataria and Sharif[49]	2020	49/F	1	2	1	1	1	0	1	- 1	6	Possible
40	Kolhe et al[50]	2020	19/F	1	2	1	1	1	0	1	- 1	6	Possible
41	Kumaran et al[51]	2020	67/F	1	2	1	1	1	1	1	- 1	7	Probable
42	Kurihara et al[52]	2020	55/M	1	0	1	0	1	0	1	- 1	3	Doubtful
43	Lakshmanan and Malik[53]	2020	68/M	1	2	1	0	1	0	1	- 1	5	Possible
44	Maalouf et al[54]	2021	62/M	1	2	1	0	1	0	1	- 1	6	Possible
45	Mazrouei et al[55]	2020	24/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
46	Meireles et al[56]	2020	36/F	1	0	1	1	1	1	1	- 1	5	Possible
47	Merza et al[57]	2020	57/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
48			70/M	1	0	1	0	- 1	0	1	- 1	1	Doubtful
49	Meyers et al[58]	2020	67/M	1	2	1	0	- 1	1	1	- 1	4	Possible
50	Miao et al[59]	2020	26/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
51	Mobin et al[60]	2020	18/M	1	2	1	0	1	0	1	- 1	5	Possible
52			66/M	1	2	1	1	- 1	0	1	- 1	4	Possible
53	Mohammadi Arbati and Molseghi[61]	2021	28/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
54	Muhammad Abrar Jeelani et al[62]	2021	24/M	1	0	1	1	1	0	1	- 1	4	Possible
55	Naqvi et al[63]	2020	69/F	1	2	1	0	1	0	1	- 1	5	Possible
56	Narang et al[64]	2021	20/F	1	2	1	0	1	1	1	- 1	6	Possible
57	Patnaik et al[65]	2020	29/M	1	2	1	0	1	0	1	- 1	5	Possible
58	Pinte and Baicus[66]	2020	47/M	1	0	1	0	1	0	1	- 1	4	Possible
59	Purayil et al[67]	2020	58/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
60	Rabice et al[68]	2020	36/F	1	2	1	1	1	0	1	- 1	6	Possible
61	Rotar et al[69]	2020	39/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
62	Sandhu et al[70]	2021	25/F	1	2	1	0	1	0	1	- 1	5	Possible
63	Shinohara et al[71]	2020	58/M	1	0	1	1	- 1	0	1	- 1	2	Doubtful
64	Simou et al[72]	2020	67/NM	1	0	1	0	- 1	0	1	- 1	1	Doubtful
65	Singh and Kharoud[73]	2020	94/F	1	2	1	0	1	1	1	- 1	6	Possible
66			58/F	1	0	1	0	1	1	1	- 1	4	Possible
67	Srinivasan et al[74]	2021	52/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
68	Tollard et al[75]	2021	32/F	1	2	1	0	1	0	1	- 1	5	Possible
69	Tomasi et al[76]	2021	31/M	1	2	1	0	1	0	1	- 1	5	Possible
70	Truscello et al[77]	2020	71/M	1	2	1	0	- 1	0	1	- 1	3	Doubtful
71	Wang et al[78]	2020	42/M	1	2	1	0	1	0	1	- 1	5	Possible
72			35/M	1	2	1	1	1	0	1	- 1	6	Possible
73	Wifi et al[79]	2021	72/F	1	2	1	0	- 1	0	1	- 1	3	Doubtful
74	Yamamoto et al[80]	2021	70/F	1	0	1	0	- 1	0	1	- 1	1	Doubtful
75	Zeng et al[81]	2020	36/M	1	2	1	0	0	0	1	- 1	4	Possible
76	Zielecki et al[82]	2020	38/M	1	0	1	1	- 1	0	1	0	3	Doubtful

¹Interpretation of the modified Naranjo score is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable.

F: Female; M: Male; NM: Not mentioned.