Acute Pancreatitis in COVID-19 Patients

Acute pancreatitis is an inflammatory condition of the pancreas characterised by abrupt onset of abdominal pain and elevated pancreatic enzymes. In the context of COVID-19, this syndrome has emerged as a notable extra-pulmonary manifestation. SARS-CoV-2 may incite pancreatic injury through direct viral entry into acinar and ductal cells via abundant angiotensin-converting enzyme 2 receptors or indirectly through systemic inflammatory responses and dysregulated immune activation. Clinically, patients present with severe epigastric pain radiating to the back, nausea, vomiting and markedly raised serum lipase or amylase. Imaging often reveals pancreatic oedema and occasionally necrosis. Reported incidence rates vary widely but appear higher among hospitalised and critically ill cohorts, where disease severity correlates with the degree of enzymatic elevation and organ dysfunction. Comorbidities such as diabetes, obesity and dyslipidaemia further compound the risk and may exacerbate multiple organ dysfunction syndrome. Recognition of drug-induced acute pancreatitis is crucial given the widespread use of corticosteroids, antiviral agents and monoclonal antibodies in COVID-19 care. Management remains largely supportive, focusing on fluid resuscitation, analgesia and early nutritional support. Although most cases resolve with conservative therapy, a subset progresses to severe or necrotising pancreatitis, necessitating intensive monitoring and multidisciplinary input. Understanding the interplay between viral pathogenicity, host response and treatment-related factors is essential for optimising outcomes and guiding future therapeutic strategies.

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Acute Pancreatitis in COVID-19 Patients publication trend

The graph below shows the total number of articles in acute pancreatitis in covid-19 patients across all publications each year (not limited to Nature Index journals).

Technical terms

Acute pancreatitis: Sudden inflammation of the pancreas causing enzymatic autodigestion and abdominal pain.

SARS-CoV-2: The virus responsible for COVID-19, which can infect pancreatic cells via ACE2 receptors.

Lipase: A pancreatic enzyme that breaks down fats; elevated blood levels signal pancreatic injury.

Angiotensin-converting enzyme 2 (ACE2): A cell-surface receptor that facilitates SARS-CoV-2 entry into host tissues, including the pancreas.

Drug-induced acute pancreatitis (DIAP): Pancreatic inflammation triggered by medications, classified by probability of causality.

Multiple organ dysfunction syndrome (MODS): Progressive failure of two or more organ systems often seen in severe inflammatory states.

References

1. Drug-Induced Acute Pancreatitis in Hospitalized COVID-19 Patients. Diagnostics (2023).
2. Clinical characteristics and short-term outcomes of acute pancreatitis among patients with COVID-19. European Journal of Medical Research (2023).
3. Deleterious Effects of SARS-CoV-2 Infection on Human Pancreatic Cells. Frontiers in Cellular and Infection Microbiology (2021).
4. Elevated Pancreatic Enzymes in ICU Patients With COVID-19 in Wuhan, China: A Retrospective Study. Frontiers in Medicine (2021).
5. Evidence showing lipotoxicity worsens outcomes in covid-19 patients and insights about the underlying mechanisms. iScience (2022).