基于病例对照的新冠疫情期间急诊科急性胰腺炎分析：UMC-19-S 的结果。
A case-control emergency department-based analysis of acute pancreatitis in Covid-19: Results of the UMC-19-S.
机构信息
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Spain.
出版信息
J Hepatobiliary Pancreat Sci. 2021 Nov;28(11):953-966. doi: 10.1002/jhbp.873. Epub 2021 Jan 7.
BACKGROUND/PURPOSE: We 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.
METHODS
We 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.
RESULTS
We 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).
CONCLUSIONS
Acute 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.
背景/目的：我们研究了在 COVID-19 大流行期间，62 家西班牙急诊室（ED）收治的住院前 COVID-19 患者中急性胰腺炎（AP）的发生率、风险因素、临床特征和结局。
方法
我们回顾性分析了在 COVID-19 大流行期间，62 家西班牙急诊室（ED）收治的所有被诊断为 AP 的 COVID 患者（占西班牙 ED 的 20%，COVID-AP）。我们形成了两个对照组：COVID 患者中无 AP（COVID-non-AP）和非 COVID 患者中无 AP（non-COVID-AP）。对病例和对照组进行了 59 项基线和临床特征以及 4 项结局的未调整比较。
结果
我们在 74814 例 COVID-19 就诊 ED 的患者中发现了 54 例 AP（发生率=0.72‰，95%CI=0.54-0.94‰）。这一频率低于非 COVID 患者（2231/1388879，1.61‰，95%CI=1.54-1.67；OR=0.44，95%CI=0.34-0.58）。AP 的病因在两组中相似，约 50%为胆源性。26 项 COVID 患者的临床特征与发生 AP 的风险增加相关：腹痛（OR=59.4，95%CI=23.7-149）、血淀粉酶升高（OR=31.8；95%CI=1.60-632）和呕吐（OR=15.8，95%CI=6.69-37.2）是最强的，一些炎症标志物（C 反应蛋白、降钙素原、血小板、D-二聚体）升高更明显。与非 COVID-AP 相比，COVID-AP 患者在 23 个变量上存在差异；最强的与 COVID 症状有关，但报告的腹痛较少，胰腺酶升高较低，入院时（根据 BISAP 和 SOFA 评分估计）严重程度较高。COVID-AP 的住院死亡率（调整年龄和性别后）与 COVID-non-AP 无差异（OR=1.12，95%CI=0.45-245），但高于非 COVID-AP（OR=2.46，95%CI=1.35-4.48）。
结论
以 ED 中出现的急性胰腺炎为表现的 COVID-19 较为少见（<1‰病例）。与其他 COVID 患者相比，存在一些有临床意义的特征，有助于识别这种不常见的表现。COVID-AP 的住院死亡率与 COVID-non-AP 无差异，但高于非 COVID-AP，COVID 患者中 AP 严重程度较高可能部分导致了这种增加。
Zotero 插件