Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2020; 26(40): 6270-6278
Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6270
Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review
Márk Félix Juhász, Klementina Ocskay, Szabolcs Kiss, Péter Hegyi, Andrea Párniczky
Márk Félix Juhász, Klementina Ocskay, Andrea Párniczky, Institute for Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Szabolcs Kiss, Doctoral School of Clinical Medicine, University of Szeged, Szeged 6720, Hungary
Péter Hegyi, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Andrea Párniczky, Department of Pediatrics, Heim Pál National Institute for Pediatrics, Budapest 1089, Hungary
Author contributions: Juhász MF and Ocskay K contributed equally, as first authors, in the systematic search and selection, data extraction, writing, preparing tables and figures; Kiss S performed the risk of bias assessment and prepared one of the tables; Hegyi P provided critical insight for the focus and writing of the article; Párniczky A contributed to the design and coordinated the writing of the paper.
Supported by European Union (European Regional Development Fund), No. GINOP-2.3.2-15-2016-00048 and EFOP 3.6.2-16-2017-00006.
Conflict-of-interest statement: Authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Andrea Párniczky, MD, PhD, Doctor, Research Fellow, Department of Pediatrics, Heim Pál National Institute for Pediatrics, Üllői Street 86, Budapest 1089, Hungary.
Received: June 17, 2020
Peer-review started: June 17, 2020
First decision: July 28, 2020
Revised: August 11, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: October 28, 2020
Research background

Since the rapid progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, numerous publications postulated pancreatic involvement. Furthermore, angiotensin-converting enzyme 2 expression -the cellular entry point of the virus- was described in the pancreas.

Research motivation

Multiple etiological factors can be uncovered in a large proportion of acute pancreatitis cases. Therefore, the characterization of SARS-CoV-2 infection as a potential contributing factor was necessary.

Research objectives

Our aim was to review all available clinical evidence on acute pancreatitis cases in coronavirus disease 2019 (COVID-19) patients and to analyze the role of COVID-19 as an etiological factor.

Research methods

A systematic search was conducted in five databases on 14 May 2020 (registration number CRD42020186426). Record selection and data extraction were carried out by two independent review authors. Studies containing the original data of at least 1 SARS-CoV-2-infected individual diagnosed with acute pancreatitis were considered eligible. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports and the Newcastle–Ottawa Scale were used for risk of bias assessment.

Research results

Eight studies (six case reports and two retrospective cohort studies) were included in this systematic review. All acute pancreatitis cases lacked proper etiological workup, but SARS-CoV-2 infection was confirmed by polymerase chain reaction in all cases. High risk of bias and non-compliance with the Case Report guideline was noted in all case reports.

Research conclusions

Guideline adherence is a quality indicator of patient care. We advise all clinicians to conduct proper etiological workup before entertaining the possibility of SARS-CoV-2 as a causative agent of acute pancreatitis.

Research perspectives

The potential mechanisms of pancreatic damage in COVID-19 should be investigated utilizing basic research methods and animal models to evaluate a possible causative association between SARS-CoV-2 and AP.