We present here the clinical and short-term outcomes of patients with acute pancreatitis (AP) admitted during the outbreak of the novel coronavirus pneumonia in China. We found that COVID-19 positive AP patients had similar mortality rates and disease severity compared to COVID-19 negative AP patients, with no statistically significant differences observed across various scoring systems. Follow-up at 1–2 months revealed that AP patients who tested positive for COVID-19 were more likely to experience cough symptoms (P = 0.04). Although there was a higher proportion of positive cases reporting abdominal pain, the difference was not statistically significant (P = 0.088).
A meta-analysis has indicated a high risk of adverse outcomes, with a mortality rate close to 20%, in patients with both AP and COVID-19 (6). However, in our study, we found no statistically significant difference in the mortality rates between AP patients with and without COVID-19 (P = 1.0). The mortality rate among AP patients with COVID-19 was 3.85%, which is considerably lower than the mortality rate reported in the literature.
The lower mortality rate observed in our study may be attributed to the fact that a majority of patients (91.7%) received vaccination. Research has shown that vaccines provide a significant level of protection against severe COVID-19, reducing hospitalization rates and mortality (7, 16). As of April 7, 2021, a total of 710 million vaccine doses have been administered globally, with at least one dose of an approved vaccine given to 5% of the world's population (17). The studies included in the article by Yang et al. (6) were published between 2020 and 2021, with most of the patients being admitted in 2020. Therefore, it can be inferred that the vaccine coverage among the patients included in Yang et al.'s article was extremely low, which could explain the lower mortality rate observed in our patients. Although there is evidence suggesting that SARS-CoV-2 can infect the pancreas and cause pancreatic injury (18), the BISAP score and Balthazar CT index indicated no difference in disease severity between the two groups. This may be due to the limited extent of pancreatic damage caused by the current strain of SARS-CoV-2, resulting in no statistically significant difference in disease severity and mortality rates between the two groups.
In our comparison of the initial laboratory test results between COVID-19 positive and negative patients on the day of admission, we found statistically significant differences (P < 0.05) in the counts of white blood cells, neutrophils, and eosinophils, while other results showed no statistically significant differences (P > 0.05). These differences may be attributed to the viral infection.
After a short-term follow-up of one month post-discharge, we found that the most commonly reported symptoms of long COVID syndrome among COVID-19 positive patients were fatigue (35%) followed by abdominal pain (30%). Although both symptoms were relatively high in proportion compared to COVID-19 negative patients, there was no statistically significant difference (P > 0.05). The only symptom that showed a statistically significant difference was cough (P = 0.04). The prevalence of cough in our COVID-19 patients after discharge (15%) was similar to what has been reported in other studies (19). Research has shown that vaccinated individuals and those infected with the Omicron variant have a lower risk of developing long COVID syndrome (20). This may explain why there was no difference in long COVID syndrome among our patients.
Additionally, studies have reported that even post-infection vaccination can alleviate long COVID syndrome (21). Therefore, it is recommended that patients who have not received the vaccine after infection should consider getting vaccinated to mitigate the symptoms of long COVID syndrome.
Limitations of the study
As this study is retrospective, there may be selection bias, and the results may not fully reflect the overall outcomes of patients with COVID-19-associated pancreatitis. Our follow-up was conducted via telephone, which introduces the possibility of recall bias. Additionally, a small proportion of patients were lost to follow-up, which could potentially impact the results. The sample size of our study was relatively small, with only 100 patients. This study was conducted at a single center, which may limit the generalizability of the results. The follow-up period was relatively short (1–2 months), and longer-term follow-up was not conducted. Long COVID-19 syndrome typically lasts for 4–8 weeks or longer. Therefore, it is possible that some patients who tested negative for COVID-19 upon admission may have been infected prior to admission or after discharge, which could introduce bias in the follow-up results of long COVID-19 syndrome.