Raised Serum Amylase in COVID-19 Patients May Not Be Acute Pancreatitis

NEW YORK (Reuters Health) – A higher-than-normal serum amylase level in patients with COVID-19 does not necessarily indicate acute pancreatitis or clinically important pancreatic injury, as has been proposed in the literature, say clinicians in the U.K.

On the contrary, “actual evidence of clinical pancreatitis secondary to SARS-CoV-2 is dubious,” Dr. Sanooj Soni and colleagues with Imperial College London write in a research letter in the British Journal of Surgery.

“Although COVID-19 infection predominantly affects the lungs, it can also injure the body in many other ways. It has previously been reported that COVID-19 infection can lead to acute pancreatitis,” Dr. Soni explained in email to Reuters Health.

To investigate further, he and his colleagues did a retrospective analysis of all COVID-19 patients admitted to intensive-care units at three London teaching hospitals between March 14 and May 22, 2020.

“Of the 234 critically ill COVID-19 patients included in our study, 67.5% had an abnormally raised amylase concentration, a commonly used blood test to assist with the diagnosis of acute pancreatitis,” Dr. Soni said. The peak value was more than three times the upper limit of normal in 52 of these patients (22.2%).

However, when reviewing radiological imaging of the abdomen, only four patients (1.7%) met the diagnostic criteria for acute pancreatitis. Furthermore, there was no association between amylase concentration and mortality, Dr. Soni told Reuters Health.

“Diagnosing acute pancreatitis can be difficult in critically unwell patients, often requiring a computed tomography (CT) scan, a process not without its risks in this cohort. In light of our results, we suggest that an abdominal CT scan is not necessarily indicated for a patient with an isolated elevated amylase concentration (unless other symptoms present such as abdominal pain),” he said.

“We hope this reassures clinicians treating critically unwell COVID-19 patients,” Dr. Soni added.

SOURCE: https://bit.ly/3aeQIvz British Journal of Surgery, online February 4, 2021.

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