Aziz Ahmed Ali, Aziz Muhammad Ali, Saleem Maleeha, Haseeb Ul Rasool Muhammad
Internal Medicine, Saint Francis Medical Center, Trenton, USA.
Internal Medicine, BronxCare Health System, New York City, USA.
Cureus. 2022 Aug 25;14(8):e28380. doi: 10.7759/cureus.28380. eCollection 2022 Aug.
There is increasing literature mentioning severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19 infection) causing acute pancreatitis (AP). It is hypothesized that SARS-Cov-2 causes pancreatic injury either by direct cytotoxic effect of the virus on pancreatic cells through the angiotensin-converting enzyme 2 (ACE2) receptors - the main receptors for the virus located on pancreatic cells - or by the cytokine storm that results from COVID-19 infection or a component of both. Many viruses are related to AP including mumps, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and as data evolves SARS-CoV-2 virus may be one of them as well. We conducted a systematic literature review to explore the current literature and provide an overview of the evidence of AP in COVID-19 infection. We studied the presence of AP in patients with SARS-CoV-2 infection and calculated the time of diagnosis of SARS-CoV-2 infection with respect to the time of diagnosis of AP. We also studied the age, gender, clinical manifestations, time of onset of symptoms, laboratory values, imaging findings, mortality, length of stay, comorbidities, need for Intensive Care Unit (ICU) care, and excluded any other common causes of AP. We included 40 articles comprising 46 patients. All patients had a positive SARS-CoV-2 polymerase chain reaction (PCR) test and all patients had AP as per Atlanta's criteria. The most common clinical presentation was abdominal pain in 29 (63.0%). Edematous pancreas was the most common Computed Tomography Abdomen Pelvis (CTAP) scan finding in these patients (35 patients). Seventeen (37%) patients required ICU admission and six (13%) patients died. Our study provides an important overview of the available data on AP in COVID-19 patients and concludes that AP is an important complication in COVID-19 infection and should be considered as an important differential in patients with COVID-19 infection who complain of abdominal pain.
越来越多的文献提到严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染（新冠病毒感染）可导致急性胰腺炎（AP）。据推测，SARS-CoV-2通过病毒对胰腺细胞的直接细胞毒性作用，经由血管紧张素转换酶2（ACE2）受体——位于胰腺细胞上的病毒主要受体——或者由新冠病毒感染引发的细胞因子风暴，或两者兼而有之，从而导致胰腺损伤。许多病毒都与急性胰腺炎有关，包括腮腺炎病毒、柯萨奇病毒、巨细胞病毒（CMV）、爱泼斯坦-巴尔病毒（EBV），随着数据的不断更新，SARS-CoV-2病毒也可能是其中之一。我们进行了一项系统的文献综述，以探究当前的文献，并概述新冠病毒感染中急性胰腺炎的证据。我们研究了SARS-CoV-2感染患者中急性胰腺炎的存在情况，并计算了SARS-CoV-2感染诊断时间与急性胰腺炎诊断时间的关系。我们还研究了患者的年龄、性别、临床表现、症状出现时间、实验室检查值、影像学检查结果、死亡率、住院时间、合并症、重症监护病房（ICU）护理需求，并排除了急性胰腺炎的任何其他常见病因。我们纳入了40篇文章，共46例患者。所有患者的SARS-CoV-2聚合酶链反应（PCR）检测均呈阳性，且根据亚特兰大标准，所有患者均患有急性胰腺炎。最常见的临床表现是腹痛，有29例（63.0%）。在这些患者中，胰腺水肿是腹部盆腔计算机断层扫描（CTAP）最常见的检查结果（35例患者）。17例（37%）患者需要入住ICU，6例（13%）患者死亡。我们的研究对新冠病毒感染患者急性胰腺炎的现有数据进行了重要概述，并得出结论：急性胰腺炎是新冠病毒感染的一种重要并发症，对于主诉腹痛的新冠病毒感染患者，应将其视为重要的鉴别诊断疾病。
