Review on acute pancreatitis attributed to COVID-19 infection

Table 1 Demographic characteristic of cases with suspected coronavirus disease 2019-attributed acute pancreatitis

Patient characteristics	Value
Age, median (range, yr)	42.0 (6-87)
Gender, male/female/NA	37/44/1
Comorbidities
Hypertension	22
Diabetes	15
Dyslipidemia	4
Heart disease	3
Cerebrovascular	0
Respiratory disease	4
Renal dysfunction	5
Obesity	16
Pregnancy	2
Malignancy	2
History of abdominal surgery	13
Others	10
Alcohol consumption, none/low/heavy/NA	53/9/0/20
History of smoking, never/experience/current/NA	32/2/0/48
Severity of COVID-19
Non-severe/severe/critical/NA	35/23/20/4
Symptoms
Fever	49
Breath shortness	16
Cough	28
Dyspnea	18
Sore throat	18
Fatigue	9
Headache	7
Myalgia	10
Anorexia	13
Diarrhea	16
Abdominal pain	75
Nausea	39
Vomiting	48
Others	23
Blood test
WBC, median (range, × 103/mm3)	13.10 (3.40-230.00)
PLT, median (range, × 103/mm3)	235.5 (52.0-502.0)
D-Dimer, median (range, μg/mL)	4.9 (0.3-17.7)
Amylase, median (range, U/L)	635 (47-4530)
Lipase, median (range, U/L)	895.5 (35.6-11920.0)
LDH, median (range, U/L)	366.0 (170-3553)
CRP, median (range, mg/dL)	8.5 (0.3-59.7)
Imaging findings (n = 75)
Pancreatic enlargement	42
Peripancreatic fluid collection	33
Peripancreatic inflammatory change	48
Pancreatic ischemic change	12
No change of pancreas	6
Not visualized	2
Severity of acute pancreatitis
Mild/moderate/severe/NA	28/20/28/6
Therapy for COVID-19
Lopinavir/ritonavir	4
Favipiravir	4
Umifenovir	2
Remdesivir	8
Hydroxychloroquine	2
Tocilizumab	2
Corticosteroid (n = 53)	21
Oxygen therapy (n = 69)	42
Mechanical ventilation	19
Therapy for acute pancreatitis
Conservative therapy/surgical drainage/NA	72/4/6
Period of hospitalization, median (range, day)	7.5 (2-76)
Prognosis
Alive/death/NA	69/10/3

RT-PCR: Reverse transcription polymerase chain reaction; IgM: Immunoglobulin M; IgG: Immunoglobulin G; WBC: White blood cell; PLT: Platelet; LDH: Lactate dehydrogenase; CRP: C-reactive protein; NA: Not available; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; COVID-19: Coronavirus disease 2019.

Table 2 Baseline characteristics of cases with coronavirus disease 2019 and acute pancreatitis coexistent

Case No.	Ref.	Age	Gender	Diagnostic evidence for SARS-CoV-2	Severity of COVID-19	Abdominal pain	Amylase/lipase (IU/L)	Abdominal image findings	Modality of image	Severity of acute pancreatitis	Treatment for pancreatitis	Prognosis
1	Anand et al[70]	59	Female	RT-PCR	Non-severe	Presence	NA/NA	Diffuse pancreatic enlargement	CT	Mild	Conservative	Alive
2	Hadi et al[71]	47	Female	RT-PCR	Critical	Absence	1500/NA	Diffuse pancreatic enlargement	AUS	Severe	NA	NA
3	Hadi et al[71]	68	Female	RT-PCR	Critical	Presence	934/NA	NA	NA	Severe	NA	NA
4	Aloysius et al[72]	36	Female	RT-PCR	Critical	Presence	325/627	No change	CT	Severe	Conservative	Alive
5	Miao et al[73]	26	Female	RT-PCR	Non-severe	Presence	NA/430	Diffuse pancreatic enlargement	CT	NA	NA	Alive
6	Szatmary et al[74]	29	Male	RT-PCR	Non-severe	Presence	77/NA	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
7	Szatmary et al[74]	47	Male	RT-PCR	Non-severe	Presence	211/NA	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
8	Rabice et al[75]	36	Female	RT-PCR	Severe	Presence	88/875	Not visualized	AUS	Mild	Conservative	Alive
9	Alloway et al[76]	7	Female	RT-PCR	Non-severe	Presence	NA/1672	Diffuse pancreatic enlargement	AUS and CT	Mild	Conservative	Alive
10	Karimzadeh et al[77]	65	Female	RT-PCR	Severe	Presence	285/294	No change	CT	Mild	Conservative	Alive
11	Gonzalo-Voltas et al[78]	76	Male	RT-PCR	Non-severe	Presence	3568/NA	Diffuse pancreatic enlargement	CT	Moderate	Conservative	Alive
12	Bokhari et al[79]	32	Male	RT-PCR	Non-severe	Presence	672/721	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Mild	Conservative	Alive
13	Mazrouei et al[80]	24	Male	RT-PCR	Non-severe	Presence	391/578	Enlargement of pancreatic tail, peripancreatic fluid collection	CT	Mild	Conservative	Alive
14	Ahmed et al[81]	47	Male	RT-PCR	Severe	Presence	349/NA	Peripancreatic inflammatory change	CT	Severe	NA	Alive
15	Brikman et al[82]	61	Male	RT-PCR	Severe	Presence	142/203	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
16	Kataria et al[83]	49	Female	RT-PCR	Severe	Presence	501/1541	Diffuse pancreatic enlargement, peripancreatic fluid collection	CT	Mild	Conservative	Alive
17	Cerda-Contreras et al[84]	72	Female	RT-PCR	Severe	Absence	1789/1247	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Severe	Conservative	Dead
18	Cheung et al[85]	38	Male	RT-PCR	Non-severe	Presence	NA/338.7	Acute pancreatitis	CT	NA	Conservative	Alive
19	Kumaran et al[86]	67	Female	RT-PCR	Severe	Presence	1483/NA	Peripancreatic inflammatory change and fluid collection, non-enhancement of most of the head and proximal body	CT	Severe	Conservative	Alive
20	Purayil et al[87]	58	Male	RT-PCR	Non-severe	Presence	249/NA	Not visualized	AUS	Mild	Conservative	Alive
21	Dietrich et al[88]	72	Male	RT-PCR	Critical	Presence	NA/185	Normal pancreas	CT	Mild	NA	Alive
22	Patnaik et al[89]	29	Male	RT-PCR	Non-severe	Presence	2861/1650	Diffuse pancreatic enlargement, peripancreatic fluid collection	CT	Mild	Conservative	Alive
23	Wang et al[90]	42	Male	RT-PCR	Critical	Presence	132/382	Pancreatic enlargement, peripancreatic fluid collection	CT	Moderate	Conservative	Dead
24	Wang et al[90]	35	Male	RT-PCR	Non-severe	Presence	NA/1042	Pancreatic enlargement, peripancreatic fluid collection	CT	Moderate	Conservative	Alive
25	Alves et al[91]	56	Female	RT-PCR	Critical	Presence	544/2993	Dffuse pancreatic enlargement, peripancreatic inflammatory change	CT and MRI	Severe	Conservative	Alive
26	Kurihara et al[92]	55	Male	RT-PCR	Critical	Absence	252/263	Pancreatic enlargement, peripancreatic inflammatory change	CT	Severe	Conservative	Alive
27	Lakshmanan and Malik[93]	68	Male	RT-PCR	Non-severe	Absence	1030/2035	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
28	Samies et al[94]	15	Male	RT-PCR	Non-severe	Presence	NA/233	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
29	Samies et al[94]	11	Male	RT-PCR	Non-severe	Presence	215/953	No change	CT	Mild	Conservative	Alive
30	Samies et al[94]	16	Female	RT-PCR	Non-severe	Presence	NA/1909	Pancreatic enlargement	CT	Mild	Conservative	Alive
31	Fernandes et al[95]	36	Female	RT-PCR	NA	Presence	710/640	Pancreatic enlargement, peripancreatic fluid collection	CT	Moderate	Conservative	Alive
32	Stevens et al[55]	10	Female	Serological IgG	Severe	Presence	NA/1371	Peripancreatic inflammatory change	CT	Severe	Conservative	Alive
33	Shinohara et al[96]	58	Male	RT-PCR	Critical	Presence	795/NA	Diffuse pancreatic enlargement peripancreatic inflammatory change	CT	Moderate	Conservative	Alive
34	Meyers et al[97]	67	Male	RT-PCR	NA	Presence	NA/5295	Interstitial edematous pancreatitis peripancreatic inflammatory change	CT	Moderate	NA	NA
35	Ghosh et al[98]	63	Male	RT-PCR	Severe	Absence	58/412	Focal pancreatic enlargement, peripancreatic fluid collection	CT	NA	Conservative	Alive
36	Tollard et al[99]	32	Female	RT-PCR	Critical	Presence	NA/321	Diffuse pancreatic enlargement peripancreatic inflammatory change	CT	Severe	Conservative	Dead
37	Kandasamy et al[100]	45	Female	RT-PCR	Severe	Presence	364/293	Diffuse pancreatic enlargement, peripancreatic inflammatory change and fluid collection	CT	Moderate	Conservative	Alive
38	Hassani et al[101]	78	Female	RT-PCR	Critical	Presence	1200/1450	Pancreatic enlargement necrotizing pancreatitis	AUS and CT	Severe	Conservative	Dead
39	Suchman et al[56]	10	Female	RT-PCR	Non-severe	Presence	NA/365.7	NA	NA	Moderate	Conservative	Alive
40	Suchman et al[56]	16	Male	RT-PCR	Critical	Presence	NA/233.3	NA	NA	Severe	Conservative	Alive
41	Narang et al[102]	20	Female	RT-PCR	Severe	Presence	1168/916	Acute pancreatitis	MRI	Severe	Conservative	Alive
42	Acherjya et al[103]	57	Female	RT-PCR	Severe	Presence	80/8352	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Moderate	Conservative	Alive
43	Alwaeli et al[104]	30	Male	RT-PCR	Critical	Presence	151/1022	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Severe	Conservative	Alive
44	Simou et al[105]	67	NA	RT-PCR	Severe	Absence	NA/576	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Severe	Conservative	Dead
45	Jespersen Nizamic et al[106]	49	Female	RT-PCR	Non-severe	Presence	NA/2864	Peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
46	Abraham et al[107]	61	Female	RT-PCR	Non-severe	Presence	NA/1018	NA	NA	Mild	Conservative	Alive
47	Abhinay et al[108]	13	Female	RT-PCR	NA	Presence	217/365	Peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
48	Bouali et al[109]	60	Female	RT-PCR	Critical	Presence	NA/627	Peripancreatic fluid collection	CT	Severe	Drainage of abdominal cavity, total gasterectomy	Dead
49	Alharmi et al[110]	52	Female	RT-PCR	Non-severe	Presence	47/NA	Atrophic pancreas, peripancreatic inflammatory change, peripancreatic fluid collection	CT	Moderate	Conservative	Alive
50	Abbas et al[57]	13	Female	RT-PCR	Critical	Presence	217.8/NA	Fluid collection	CT	Severe	Conservative	Alive
51	Bineshfar et al[111]	14	Male	RT-PCR	Non-severe	Presence	1914/NA	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Mild	Conservative	Alive
52	Paz et al[112]	14	Male	RT-PCR	Non-severe	Presence	196/247	Peripancreatic inflammatory change, fluid collection	MRI	Mild	Conservative	Alive
53	Wifi et al[113]	72	Female	RT-PCR	Non-severe	Presence	1667/710	No change	CT	Mild	Conservative	Alive
54	Sandhu et al[114]	25	Female	RT-PCR	Critical	Presence	350/35.6	Diffuse pancreatic enlargement	CT	Severe	Conservative	Dead
55	Mohammadi Arbati et al[115]	28	Male	RT-PCR	Critical	Presence	1273/758	Peripancreatic inflammatory change, fluid collection, acute necrotic pancreatitis	CT	Severe	Conservative	Alive
56	Amé et al[116]	42	Female	RT-PCR	NA	Presence	2263/2799	Pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	NA	Conservative	Alive
57	Gupta et al[117]	25	Female	RT-PCR	Severe	Presence	1814/11920	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Severe	Conservative	Alive
58	Muhammad Abrar Jeelani et al[118]	24	Male	RT-PCR	Non-severe	Presence	NA/4174	Peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
59	Maalouf et al[119]	62	Male	RT-PCR	Non-severe	Presence	NA/4361	Peripancreatic inflammatory change, necrotic collection	MRI	Moderate	Conservative	Alive
60	Sanchez et al[120]	16	Male	RT-PCR	Severe	Presence	NA/961	Peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
61	Ehsan et al[121]	13	Female	RT-PCR	Severe	Presence	598/2331	Peripancreatic inflammatory change, fluid collection	CT	Moderate	Conservative	Alive
62	Hanif et al[122]	30	Female	RT-PCR	Severe	Presence	820/626	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Severe	Conservative	Alive
63	Chandra et al[123]	53	Male	RT-PCR	Critical	Presence	NA/1200	Peripancreatic inflammatory change	CT	Severe	Conservative	Alive
64	Alfishawy et al[124]	17	Male	RT-PCR	Severe	Absence	285/273	Pancreatic loculations	CT	Moderate	Conservative	Alive
65	Berrichi et al[125]	36	Female	RT-PCR	Critical	Presence	NA/2570	Diffuse pancreatic enlargement, peripancreatic inflammatory change	CT	Severe	Conservative	Dead
66	Berrichi et al[125]	51	Female	RT-PCR	Severe	Presence	NA/676	Diffuse pancreatic enlargement	CT	Mild	Conservative	Alive
67	Kripalani et al[126]	79	Female	RT-PCR	Critical	Presence	1075/6178	Diffuse pancreatic enlargement, peripancreatic inflammatory change, acute necrotic pancreatitis	CT	Severe	Cycto-jejunostomy	Alive
68	Narayan et al[127]	28	Male	RT-PCR	Critical	Presence	Elevated/elevated	Diffuse pancreatic enlargement, peripancreatic inflammatory change and acute necrotic pancreatitis	CT	Severe	Conservative	Dead
69	Narayan et al[127]	45	Female	RT-PCR	Severe	Presence	Elevated/elevated	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
70	Eldaly et al[128]	44	Male	RT-PCR	Non-severe	Presence	773/286	Diffuse pancreatic enlargement	CT	Mild	Conservative	Alive
71	Basukala et al[129]	49	Female	RT-PCR	Non-severe	Presence	1563/568	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection, necrotic pancreatitis	CT	Severe	Gastrocolic ligament and followed by necrotic debridement, and drainage placement	Dead
72	Schembri Higgans et al[130]	63	Female	RT-PCR	Non-severe	Presence	1079/NA	After Whipple surgery	CT	Mild	Conservative	Alive
73	Schembri Higgans et al[130]	87	Female	RT-PCR	Non-severe	Presence	499/NA	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
74	Schembri Higgans et al[130]	64	Female	RT-PCR	Non-severe	Presence	2141/NA	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive
75	Kopiczko et al[131]	6	Female	RT-PCR	Non-severe	Presence	1124/4250	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Mild	Conservative	Alive
76	Kareva et al[58]	11	Male	Serological IgG	Non-severe	Presence	489/576	Edematous appendix no change of pancreas	AUS	NA	Conservative	Alive
77	da Costa Ferreira et al[132]	35	Male	RT-PCR	Severe	Presence	1669/NA	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection normal gallbladder and biliary tract	CT	Severe	Conservative	Alive
78	Sánchez-Gollarte et al[133]	60	Male	Serological IgG	Severe	Presence	4530/2220	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection, necrotic pancreatitis	CT	Severe	Drainage of abdominal cavity	Alive
79	Sudarsanam et al[134]	35	Male	RT-PCR	Non-severe	Presence	Normal/normal	Peripancreatic inflammatory change, fluid collection, necrotic pancreatitis of tail	CT	NA	Conservative	Alive
80	Faghih Dinevari et al[135]	18	Female	RT-PCR	Non-severe	Presence	1288/1541	Diffuse pancreatic enlargement, peripancreatic inflammatory change, fluid collection	CT	Mild	Conservative	Alive
81	Goldstein et al[136]	11	Male	Serological IgG	Severe	Presence	1607/2434	Peripancreatic inflammatory change, fluid collection, necrotic pancreatitis	MRI	Moderate	Conservative	Alive
82	Gadiparthi et al[137]	74	Female	RT-PCR	Non-severe	Presence	229/7550	Peripancreatic inflammatory change	CT	Mild	Conservative	Alive

RT-PCR: Reverse transcription polymerase chain reaction; IgG: Immunoglobulin G; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; COVID-19: Coronavirus disease 2019; AUS: Abdominal ultrasonography; CT: Computed tomography; MRI: Magnetic resonance imaging; NA: Not available.

Table 3 The probability of other etiologies of acute pancreatitis in cases with coronavirus disease 2019 and acute pancreatitis coexistent

Case No.	Alcohol	Biliary	Hypertriglyceridemia	Drug	Acute aggravation on chronic pancreatitis	Hypercalcemia	Infections	Ischemia/reperfusion	Trauma/ anatomy	Genetics	MIS-C/PIMS
1	N	?	?	Y	N	?	?	N	N	-	-
2	N	N1	N	?	N	N	?	Y	N	-	-
3	?	?	N	?	N	N	?	Y	N	-	-
4	N	N	N	N	N	?	?	N	N	-	-
5	N	N	N	N	N	N	N2	N	N	-	-
6	N	N	N	N	N	?	?	?	N	-	-
7	N	N	N	N	N	?	?	?	N	-	-
8	N	N	N	N	N	?	?	N	N	-	-
9	N	?	?	N	N	?	?	N	N	?	N
10	?	N	N	N	N	N	?	N	N	-	-
11	N	N	?	Y	N	?	?	N	N	-	-
12	N	N	N	N	N	N	?	N	N	-	-
13	N	N	?	N	N	?	?	N	N	-	-
14	?	Y	?	Y	N	?	?	N	N	-	-
15	N	N	N	Y	N	N	?	N	N	-	-
16	N	N	N	Y	N	N	?	N	N	-	-
17	?	?	N	Y	N	N	?	Y	N	-	-
18	N	N	N	N	N	N	?	N	N	-	-
19	N	N	N	N	N	N	?	N	N	-	-
20	N	N	?	N	N	?	?	N	N	-	-
21	N	N	?	N	N	?	?	N	N	-	-
22	N	N	N	N	N	N	?	N	N	-	-
23	N	N	N	N	N	N	?	N	N	-	-
24	N	N	N	N	N	N	?	N	N	-	-
25	N	N	N	N	N	N	?	N	N	-	-
26	?	N	N	Y	N	N	?	Y	N	-	-
27	N	N	N	N	N	N	?	N	N	-	-
28	N	?	N	N	N	?	?	N	N	N	N
29	N	N	N	N	N	?	?	N	N	N	?
30	N	Y	N	N	Y	?	?	N	N	N	N
31	N	N1	?	N	N	?	?	N	N	-	-
32	N	Y	N	N	N	?	?	N	N	?	Y
33	N	N	N	Y	N	N	?	Y	N	-	-
34	N	N	N	N	N	?	?	N	N	-	-
35	N	?	?	?	N	?	?	N	N	-	-
36	N	Y	N	N	N	N	?	Y	N	-	-
37	N	N	?	N	N	?	?	N	N	-	-
38	N	N	N	N	N	N	?	N	N	-	-
39	N	?	?	?	N	?	?	?	?	?	Y
40	N	?	?	?	N	?	?	?	?	?	N
41	N	N	N	Y	N	?	?	Y	N	-	-
42	N	N	N	Y	N	N	?	N	N	-	-
43	N	N	N	N	N	N	N2	N	N	-	-
44	N	N	N	Y	N	N	N2	Y	N	-	-
45	N	?	?	N	N	?	?	N	N	-	-
46	?	?	?	N	N	N	?	N	N	-	-
47	?	?	?	N	N	?	?	N	N	?	N
48	?	?	?	N	N	?	?	N	N	-	-
49	N	N	N	Y	N	N	?	N	N	-	-
50	N	N	N	Y	N	?	N2	N	N	N	Y
51	N	N	?	N	N	?	?	N	N	?	N
52	?	N	N	N	N	?	?	N	N	N	N
53	?	N	N	N	N	N	?	N	N	-	-
54	N	Y	N	N	N	N	?	N	N	-	-
55	N	N	N	N	N	N	?	N	N	-	-
56	N	N	N	N	N	N	?	N	N	-	-
57	N	N	N	?	N	N	?	N	N	-	-
58	N	N	N	N	N	N	?	N	N	-	-
59	N	N	N	N	N	?	?	N	N	-	-
60	N	N	?	N	N	N	?	N	N	N	N
61	N	N	N	N	N	?	?	N	N	?	?
62	N	?	N	Y	N	N	N	Y	N	-	-
63	N	N	N	N	N	?	?	N	N	-	-
64	N	Y	Y	N	N	?	?	N	N	?	?
65	?	N	?	N	N	?	?	N	N	-	-
66	?	N	?	N	N	?	?	N	N	-	-
67	N	N	?	N	N	?	?	N	N	-	-
68	?	N	N	Y	N	?	?	N	N	-	-
69	?	?	?	Y	N	?	?	Y	N	-	-
70	N	N	N	N	N	?	?	N	N	-	-
71	N	N	N	N	N	N	?	N	N	-	-
72	N	N	?	N	N	?	?	N	Y	-	-
73	?	N	N	N	N	?	?	N	N	-	-
74	?	Y	?	N	N	?	?	N	N	-	-
75	N	N	N	N	N	N	N	N	N	?	N
76	N	N	?	N	N	N	?	N	N	?	Y
77	N	Y	N	N	N	N	?	N	N	-	-
78	?	N	?	?	N	N	?	N	N	-	-
79	N	N	N	N	N	N	?	N	N	-	-
80	N	N	N	N	N	N	?	N	N	N	N
81	?	?	?	Y	N	?	N2	N	N	?	Y
82	N	N	N	N	N	N	?	N	N	-	-

¹Serological hepatobiliary test was not shown.

²Some infections were denied although others were not.

Y: Probable; N: Improbable; MIS-C: Multisystemic inflammatory syndrome in children; PIMS: Pediatrics inflammatory multisystem syndrome.