• Òscar Miró, Pere Llorens, Sònia Jiménez, Pascual Piñera, Guillermo Burillo-Putze, Alfonso Martín, Francisco J Martín-Sánchez, Jorge Lamberechts, Aitor Alquézar-Arbé, Javier Jacob, José Noceda, María J Cano Cano, María J Fortuny Bayarri, Juan M Marín Porrino, Napoleón Meléndez, Carles Pérez García, José V Brasó Aznar, María C Ponce, Elena Díaz Fernández, Laura Ejarque Martínez, Ana Peiró Gómez, Josep Tost, María J Domínguez, Francisco J Teigell Muñoz, Juan González Del Castillo, and Spanish Investigators on Emergency Situations TeAm (SIESTA) network.
• Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
• J Hepatobiliary Pancreat Sci. 2020 Dec 1.

Background/PurposeWe investigated the incidence, risk factors, clinical characteristics and outcomes of acute pancreatitis (AP) in patients with COVID-19 attending the emergency department (ED), before hospitalization.MethodsWe retrospectively reviewed all COVID patients diagnosed with AP in 62 Spanish EDs (20% of Spanish EDs, COVID-AP) during the COVID outbreak. We formed two control groups: COVID patients without AP (COVID-non-AP) and non-COVID patients with AP (non-COVID-AP). Unadjusted comparisons between cases and controls were performed regarding 59 baseline and clinical characteristics and four outcomes.ResultsWe identified 54 AP in 74 814 patients with COVID-19 attending the ED (frequency = 0.72‰, 95% CI = 0.54-0.94‰). This frequency was lower than in non-COVID patients (2231/1 388 879, 1.61‰, 95% CI = 1.54-1.67; OR = 0.44, 95% CI = 0.34-0.58). Etiology of AP was similar in both groups, being biliary origin in about 50%. Twenty-six clinical characteristics of COVID patients were associated with a higher risk of developing AP: abdominal pain (OR = 59.4, 95% CI = 23.7-149), raised blood amylase (OR = 31.8; 95% CI = 1.60-632) and vomiting (OR = 15.8, 95% CI = 6.69-37.2) being the strongest, and some inflammatory markers (C-reactive protein, procalcitonin, platelets, D-dimer) were more increased. Compared to non-COVID-AP, COVID-AP patients differed in 23 variables; the strongest ones related to COVID symptoms, but less abdominal pain was reported, pancreatic enzymes raise was lower, and severity (estimated by BISAP and SOFA score at ED arrival) was higher. The in-hospital mortality (adjusted for age and sex) of COVID-AP did not differ from COVID-non-AP (OR = 1.12, 95% CI = 0.45-245) but was higher than non-COVID-AP (OR = 2.46, 95% CI = 1.35-4.48).ConclusionsAcute pancreatitis as presenting form of COVID-19 in the ED is unusual (<1‰ cases). Some clinically distinctive characteristics are present compared to the remaining COVID patients and can help to identify this unusual manifestation. In-hospital mortality of COVID-AP does not differ from COVID-non-AP but is higher than non-COVID-AP, and the higher severity of AP in COVID patients could partially contribute to this increment.© 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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