a comprehensive analysis of outcomes between covid 19 patients with an elevated serum CORD-Papers-2021-10-25 (Version 1)

Title: A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis.
Abstract: Background and Aims: COVID-19 patients may have asymptomatic hyperlipasemia without abdominal imaging findings or abdominal pain. In addition, primary and secondary pancreatitis have been described in COVID-19 patients. There is limited information on how the groups compare in outcomes. The aim is to compare outcomes among these groups. Methods: This is a retrospective study from 12 hospitals within one healthcare system examining outcomes between hospitalized COVID-19 patients with a lipase <3x upper limit of normal (ULN), asymptomatic hyperlipasemia (>3x ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis). Results: Of 11,883 patients admitted with COVID-19, 1,560 patients were included: 1,155 COVID-19 patients with a normal serum lipase (control group), 270 with an elevated lipase <3x ULN, 46 patients with asymptomatic hyperlipasemia with a lipase 3xULN, 57 patients with secondary pancreatitis, and 32 patients with primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3x ULN and asymptomatic hyperlipasemia groups had worse outcomes. The mortality was OR1.6 (95% CI 1.2-2.2) and 1.1 (95% CI 0.5-2.3), respectively. The need for mechanical ventilation was OR 2.8 (95% CI 1.2-2.1) and 2.8 (95% CI 1.5-5.2), respectively. Longer length of stay was OR 1.5 (95%CI 1.1-2.0) and 3.16 (95%CI 1.5-6.5), respectively. Conclusion: COVID-19 patients with an elevated lipase< 3x ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis. This could be attributed to extrapancreatic causes (liver failure, renal failure, enteritis, etc), which may signify a more severe course of clinical disease. Key words: pancreas; SARS-CoV-2; pancreatitis
Published: 4/14/2021
DOI: 10.1101/2021.04.13.21252871
DOI_URL: http://doi.org/10.1101/2021.04.13.21252871
Author Name: Benias, P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/benias_p
Author Name: Inamdar, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/inamdar_s
Author Name: Wee, D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/wee_d
Author Name: Liu, Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y
Author Name: Buscaglia, J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/buscaglia_j
Author Name: Satapathy, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/satapathy_s
Author Name: Trindade, A J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/trindade_a_j
sha: bb8742b2e817508f5b599c479d19e040358d5813
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: http://medrxiv.org/cgi/content/short/2021.04.13.21252871v1?rss=1 https://doi.org/10.1101/2021.04.13.21252871
has_full_text: TRUE
Keywords Extracted from Text Content: islet cells pancreatic lipase 8 pancreatitis ULN liver Northwell Health System lipase 3xULN patient COVID-19 abdominal pancreatic injury 5 cancer O u t c o m e R e s u l t pulmonary OR1.6 upper pancreas lipase b l e 2 o f t h e S t u d y enteritis kidney U S T E D A D J U S T E Patient medRxiv serum Staten Island COVID-19 3 ACE2 3xULN extrapancreatic acute pancreatitis [3] [4] [5 serum lipase ptients upper abdominal renal Patients heart intestine Serum lipase SARS-CoV-2 nonpancreatic COVID-19 patients organs congestive heart lipase patients Pancreatic lipase pancreas
Extracted Text Content in Record: First 5000 Characters:. This is a retrospective study from 12 hospitals within one healthcare system examining outcomes between hospitalized COVID-19 patients with a lipase <3x upper limit of normal (ULN), asymptomatic hyperlipasemia (>3x ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis). R e s u l t s : Of 11,883 patients admitted with COVID-19, 1,560 patients were included: 1,155 COVID-19 patients with a normal serum lipase (control group), 270 with an elevated lipase <3x ULN, 46 patients with asymptomatic hyperlipasemia with a lipase 3xULN, 57 patients with secondary pancreatitis, and 32 patients with primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3x ULN and asymptomatic hyperlipasemia groups had worse outcomes. The mortality was OR1.6 (95% CI 1.2-2.2) and 1.1 (95% CI 0.5-2.3), respectively. The need for mechanical ventilation was OR 2.8 (95% CI 1.2-2.1) and 2.8 (95% CI 1.5-5.2), respectively. Longer length of stay was OR 1.5 (95%CI 1.1-2.0) and 3.16 (95%CI 1.5-6.5), respectively. Conclusion: COVID-19 patients with an elevated lipase< 3x ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis. This could be attributed to extrapancreatic causes (liver failure, renal failure, enteritis, etc), which may signify a more severe course of clinical disease. Key words: pancreas; SARS-CoV-2; pancreatitis All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. that COVID-19 can also present primarily as acute pancreatitis [3] [4] [5] . The mechanism of injury in these cases is hypothesized to be via SARS-CoV-2 binding to islet cells of the pancreas that contain ACE2 receptors causing subsequent pancreatic injury 5 . While some patients present with clear symptoms of pancreatitis, others have been noted to simply have asymptomatic hyperlipasemia 6 with varying degrees of elevation of serum lipase. It is generally agreed upon that significant serum lipase elevation for a diagnosis of pancreatitis is three times the upper limit of normal 7 . Other organs can also secrete lipase such as the liver, kidney, and small intestine; although at generally lower serum concentrations than pancreatic lipase 8, 9 . An elevated serum lipase may also reflect impaired clearance secondary to liver or renal failure 10 . Acute pancreatitis requires two of the following as per the revised Atlanta classification: 1) lipase greater than three times the upper limit of normal, 2) cross sectional imaging (computed tomography or magnetic resonance imaging) showing pancreatitis, and 3) characteristic upper abdominal pain at hospital admission 7 . It is unclear how outcomes (mortality, need for mechanical ventilation, and length of stay) compare in COVID-19 patients with elevated lipase <3x ULN, asymptomatic hyperlipasemia with a lipase >3xULN, and pancreatitis compared to COVID-19 patients with a normal lipase. The aim of our study is to compare these outcomes among these groups. This is a retrospective observational cohort study of COVID-19 patients 18 years or older admitted to twelve hospitals within the Northwell Health System from March 1, 2020-June 1, 2020 during the COVID-19 pandemic in New York. Institutional Review Board approval (IRB #20-0200, Registry of patients who are presenting under the suspicion of All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 14, 2021. ; The following patient groups were compared: COVID-19 patients with a normal lipase, COVID-19 patients with an elevated lipase but less than 3x ULN, COVID-19 patients with a lipase >3xULN but without pancreatitis (no imaging concerning for pancreatitis or abdominal pain), COVID-19 patients with primary pancreatitis (presenting with acute pancreatitis and subsequently found to have COVID-19), and COVID-19 patients with secondary pancreatitis (patients presenting with respiratory COVID-19 symptoms (e.g. shortness of breath and fever) and found to have pancreatitis). The primary pancreatitis group has been previously reported 11 . Patient charts with a lipase >3xULN were subsequently individually reviewed to determine the etiology of pancreatitis if applicable, why a serum lipase was ordered, and to confirm group categorization. Patients with acute pancreatitis met the revised Atlanta classification (as previously defined). The primary outcomes of mortality, lengths of stay, and need for mechanical ventilation were compared between the groups. Univariate and bivariate analysis was performed using students' t-test or ANOVA for comparison of continuous variables, and Chi square test for
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