A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis

  1. Petros C Benias
  2. Sumant Inamdar
  3. Diana Wee
  4. Yan Liu
  5. Jonathan M Buscaglia
  6. Sanjaya K Satapathy
  7. Arvind J Trindade
  8. Northwell COVID-19 Research Consortium.

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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.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.13.21252871: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Institutional Review Board approval (IRB #20-0200, Registry of patients who are presenting under the suspicion of COVID-19) was obtained for this study by the Northwell Health Feinstein Institute for Medical Research, Office of the Human Research Protection Program (Hallie Kassan, MD; Director).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Institutional Review Board approval (IRB #20-0200, Registry of patients who are presenting under the suspicion of COVID-19) was obtained for this study by the Northwell Health Feinstein Institute for Medical Research, Office of the Human Research Protection Program (Hallie Kassan, MD; Director).
    Human Research Protection Program
    suggested: None
    SAS, Version 9.4 (SAS Institute, Cary, NC) was used to perform all analysis.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. First, it is retrospective in design and thus has its inherit limitations. Second, a serum lipase was ordered as part of a critical care serum panel for ill patients and thus may bias towards sicker patients. Finally the hypothesis that the COVID-19 group with lipase <3xULN and the COVID-19 group with asymptomatic hyperlipasemia (no imaging concerning for pancreatitis or abdominal pain) likely have an elevated lipase due to a nonpancreatic source can only truly be proven by fractionating the lipase which was not done in these patients as it is not part of standard clinical care. In conclusion, this study attempts to provide clarity regarding hyperlipasemia in patients with COVID-19. We found that COVID-19 patients with a lipase <3x ULN and asymptomatic hyperlipasemia with a lipase > 3xULN generally have worse outcomes compared to those with pancreatitis. Future studies from similar large health systems may be need to confirm our findings.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2021.04.13.21252871v1 on medRxiv