# COVID‐19–Induced Acute Pancreatitis: Clinical Profiles, Outcomes, and Prognostic Indicators From a Global Review‐Based Synthesis

## TL;DR

This study examines how and why some COVID-19 patients develop acute pancreatitis, identifying key symptoms and risk factors for poor outcomes.

## Contribution

The paper introduces a clear definition of 'COVID-19–induced AP' and identifies specific prognostic indicators not previously well established.

## Key findings

- Higher white blood cell count and surgical intervention were linked to increased mortality in COVID-19–induced AP.
- The AST-to-ALT ratio ≥ 2 was an independent predictor of mortality in these patients.
- Symptom chronology did not affect overall survival in patients with COVID-19–induced AP.

## Abstract

During the coronavirus disease 2019 (COVID‐19) pandemic, acute pancreatitis (AP) in patients with COVID‐19 has attracted considerable attention. While many reports have described “concurrent COVID‐19 and AP” without excluding established etiologies, the concept of “COVID‐19–induced AP” remains less clearly defined. This study aimed to investigate the associations between initial clinical presentations and outcomes in COVID‐19–induced AP, offering real‐world evidence to identify predictors of short‐term prognosis.

This is a review‐based synthesis for human studies, with literature search (October 2019–March 2022) using PubMed dual strategies, “Medical Subject Headings (MeSH)” and “title/abstract.” COVID‐19–induced AP was defined by the exclusion of other established etiologies for pancreatitis.

We identified 111 patients (median age 39 years) with 11 deaths. Gastrointestinal symptoms preceded admission in 30.6% of cases, while respiratory symptoms preceded admission in 52.3%. Pancreatitis symptoms before admission were associated with younger age, less lymphocyte counts, lower neutrophil‐to‐lymphocyte ratio, and higher radiologic severity (Balthazar score). Initial white blood cell (WBC) count ≥ 14,000/µL and pancreatic necrosis correlated with surgical intervention. Kaplan–Meier analysis demonstrated that overall survival was not influenced by the sequence of gastrointestinal and respiratory symptom onset (concurrent vs. successive; p = 0.543) or by whether pancreatitis symptoms developed before or after hospital admission (p = 0.228). Multivariate Cox regression identified elevated WBC count (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.000–1.025; p = 0.042), AST‐to‐ALT ratio ≥ 2 (HR: 11.052; 95% CI: 1.441–84.770; p = 0.021), and surgical intervention (HR: 6.604; 95% CI: 1.581–27.593; p = 0.010) as independent mortality predictors.

Unlike “concurrent COVID‐19 and AP (without excluding established AP etiologies),” “COVID‐19–induced AP” showed no survival disparity by symptom chronology. Mortality was linked to leukocytosis, AST‐to‐ALT ratio, and surgical intervention. Standardized terminology distinguishing “COVID‐19–induced AP” from “concurrent COVID‐19 and AP” is essential to ensure comparability of global clinical data and reduce interpretive bias.