Candelli Marcello, Calce Roberta, Pignataro Giulia, Racco Simona, Fuorlo Mariella, Barone Fabiana, Piccioni Andrea, Merra Giuseppe, Ojetti Veronica, Gasbarrini Antonio, Franceschi Francesco
Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy.
Translational Medicine and Surgery Department, Medicine and Surgery Faculty of Rome, Università Cattolica del Sacro Cuore di Milano, Rome, Italy.
Intern Emerg Med. 2025 Aug 20. doi: 10.1007/s11739-025-04087-y.
Elevated serum amylase has been frequently observed in COVID-19 patients, but whether hyperamylasemia results from a direct or indirect pancreatic effect or other mechanisms remains debated. Our study aimed to investigate the association between hyperamylasemia, pancreatitis, and COVID-19 severity. We retrospectively analyzed 1858 patients who visited the emergency department of Fondazione Policlinico Gemelli-IRCCS in Rome during the first two years of the pandemic. All had a confirmed COVID-19 diagnosis and underwent serum amylase evaluation. Clinical and laboratory data, including oxygen therapy requirements, intensive care unit (ICU) admission, and mortality, were extracted from electronic medical records. Univariate analysis revealed a correlation between hyperamylasemia and blood urea nitrogen, ICU admission, multiple comorbidities, and D-dimer levels. Multivariable logistic regression, adjusted for age, sex, comorbidities, and blood urea nitrogen, confirmed that ICU admission-but not in-hospital mortality-was independently associated with hyperamylasemia. Acute pancreatitis was diagnosed in only four patients. Elevated serum amylase levels appear more related to disease severity than direct pancreatic involvement. Emergency physicians should recognize that hyperamylasemia detected upon emergency department admission in COVID-19 patients may indicate an increased risk of ICU admission rather than acute pancreatitis, warranting closer evaluation and management.
新冠病毒肺炎（COVID-19）患者中经常观察到血清淀粉酶升高，但高淀粉酶血症是由直接或间接的胰腺效应还是其他机制引起的仍存在争议。我们的研究旨在调查高淀粉酶血症、胰腺炎与COVID-19严重程度之间的关联。我们回顾性分析了疫情头两年期间在罗马的圣心天主教大学综合医院-IRCCS急诊科就诊的1858例患者。所有患者均确诊为COVID-19，并接受了血清淀粉酶评估。从电子病历中提取了临床和实验室数据，包括氧疗需求、重症监护病房（ICU）收治情况和死亡率。单因素分析显示高淀粉酶血症与血尿素氮、ICU收治、多种合并症和D-二聚体水平之间存在相关性。在对年龄、性别、合并症和血尿素氮进行校正的多变量逻辑回归分析中，证实ICU收治——而非院内死亡率——与高淀粉酶血症独立相关。仅4例患者被诊断为急性胰腺炎。血清淀粉酶水平升高似乎与疾病严重程度的关系更大，而非直接的胰腺受累。急诊科医生应认识到，COVID-19患者在急诊科就诊时检测到的高淀粉酶血症可能表明ICU收治风险增加，而非急性胰腺炎，需要进行更密切的评估和管理。
