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Ge P, Luo Y, Liu J, Liu J, Wen H, Zhang G, Chen H. Eliminating COVID-19 as the immediate culprit for igniting pancreatitis. J Med Virol 2023; 95:e29272. [PMID: 38054501 DOI: 10.1002/jmv.29272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
The impact of severe acute respiratory syndrome coronavirus 2 infection on the potential development of pancreatitis is a subject of ongoing debate within academic discourse. Establishing a causal link between COVID-19 and pancreatitis may not be fully supported by relying only on retrospective studies or case reports. This study examined the relationship between COVID-19 phenotypes and pancreatitis by Mendelian randomization (MR) method. The identification of instrumental variables (single nucleotide polymorphisms) that exhibit a robust association with the COVID-19 phenotypes was accomplished through a meticulous process of rigorous screening procedures. We included acute pancreatitis and chronic pancreatitis (CP) as the outcomes in the MR analysis, even though no definitive studies exist between COVID-19 and CP. A direct causal relationship between genetically predicted COVID-19 phenotypes and pancreatitis risk cannot be established. There is an ongoing debate over the designation of COVID-19 as a definitive cause of pancreatitis.
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Affiliation(s)
- Peng Ge
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yalan Luo
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jin Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haiyun Wen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guixin Zhang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hailong Chen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Correia de Sá T, Rocha M. The Pancreas in Coronavirus Disease 2019 Infection. Gastroenterol Clin North Am 2023; 52:37-48. [PMID: 36813429 PMCID: PMC9744682 DOI: 10.1016/j.gtc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An association between acute pancreatitis (AP) and coronavirus disease 2019 (COVID-19) has been proposed but the mechanisms of pancreatic injury of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the implicative role on the development of AP are not yet fully understood. COVID-19 also imposed major challenges on pancreatic cancer management. We conducted an analysis on the mechanisms of pancreatic injury by SARS-CoV-2 and reviewed published case reports of AP attributed to COVID-19. We also examined the pandemic effect on pancreatic cancer diagnosis and management, including pancreatic surgery.
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Affiliation(s)
- Tiago Correia de Sá
- General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007 Penafiel, Portugal.
| | - Mónica Rocha
- Hepato-Pancreato-Biliary Unit, General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007 Penafiel, Portugal
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To Establish an Early Prediction Model for Acute Respiratory Distress Syndrome in Severe Acute Pancreatitis Using Machine Learning Algorithm. J Clin Med 2023; 12:jcm12051718. [PMID: 36902504 PMCID: PMC10002486 DOI: 10.3390/jcm12051718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To develop binary and quaternary classification prediction models in patients with severe acute pancreatitis (SAP) using machine learning methods, so that doctors can evaluate the risk of patients with acute respiratory distress syndrome (ARDS) and severe ARDS at an early stage. METHODS A retrospective study was conducted on SAP patients hospitalized in our hospital from August 2017 to August 2022. Logical Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), and eXtreme Gradient Boosting (XGB) were used to build the binary classification prediction model of ARDS. Shapley Additive explanations (SHAP) values were used to interpret the machine learning model, and the model was optimized according to the interpretability results of SHAP values. Combined with the optimized characteristic variables, four-class classification models, including RF, SVM, DT, XGB, and Artificial Neural Network (ANN), were constructed to predict mild, moderate, and severe ARDS, and the prediction effects of each model were compared. RESULTS The XGB model showed the best effect (AUC = 0.84) in the prediction of binary classification (ARDS or non-ARDS). According to SHAP values, the prediction model of ARDS severity was constructed with four characteristic variables (PaO2/FiO2, APACHE II, SOFA, AMY). Among them, the overall prediction accuracy of ANN is 86%, which is the best. CONCLUSIONS Machine learning has a good effect in predicting the occurrence and severity of ARDS in SAP patients. It can also provide a valuable tool for doctors to make clinical decisions.
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Zhou Y, Ge YT, Yang XX, Cai Q, Ding YB, Hu LH, Lu GT. Prevalence and Outcomes of Pancreatic Enzymes Elevation in Patients With COVID-19: A Meta-Analysis and Systematic Review. Front Public Health 2022; 10:865855. [PMID: 35646804 PMCID: PMC9133915 DOI: 10.3389/fpubh.2022.865855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023] Open
Abstract
Background Although coronavirus disease 2019 (COVID-19) is considered to be a disease that mainly involves the respiratory system, an increasing number of studies have reported that COVID-19 patients had pancreatic enzymes (PE) elevation and even pancreatic injury. The study aims to determine the prevalence of PE elevation, and the relationship between elevated PE and prognosis in COVID-19 patients. Methods A comprehensive literature search was conducted according to the PRISMA guideline in PubMed, Embase, Scopus, Web of Science, and Google Scholar for studies reporting PE elevation in patients with COVID-19 from 1st January 2020 to 24th November 2021. Results A total of 13 studies (24,353 participants) were included in our review. The pooled prevalence of PE elevation in COVID-19 patients was 24% (18%-31%), the pooled odds ratio (OR) of mortality was 2.5 (1.7-3.6), the pooled OR of ICU admission was 4.4 (2.8-6.8), and the pooled OR of kidney injury, respiratory failure and liver injury were 3.5 (1.6-7.4), 2.0 (0.5-8.7), and 2.3 (1.4-3.9) respectively. In addition, the subgroup analysis revealed that although PE elevated to > 3 × upper normal limit (ULN) was significantly related to the mortality (OR = 4.4, 2.1-9.4), it seemed that mild elevation of PE to 1-3 ULN also had a considerable risk of mortality (OR = 2.3, 1.5-3.5). Conclusions PE elevation was a common phenomenon in patients with COVID-19, and was associated with poor clinical outcomes. However, due to the limited numbers of included studies, the result of our study still needed to be validated. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=295630, identifier: CRD42021295630.
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Affiliation(s)
- You Zhou
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Nursing, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yu-Tong Ge
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Xi Yang
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qian Cai
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yan-Bing Ding
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Guo-Tao Lu
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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Yang F, Xu Y, Dong Y, Huang Y, Fu Y, Li T, Sun C, Pandanaboyana S, Windsor JA, Fu D. Prevalence and prognosis of increased pancreatic enzymes in patients with COVID-19: A systematic review and meta-analysis. Pancreatology 2022; 22:539-546. [PMID: 35361531 PMCID: PMC8949660 DOI: 10.1016/j.pan.2022.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The prevalence of increased pancreatic enzymes (elevated serum amylase and/or lipase) and its relationship to clinical outcomes in patients with coronavirus disease 2019 (COVID-19) infection is not known. METHODS A systematic review and meta-analysis of relevant studies reporting prevalence and impact of increased pancreatic enzymes (defined as an elevation in amylase and/or lipase levels above the upper limit of normal [ULN] value) in COVID-19 was undertaken. RESULTS A total of 36,496 patients from 21 studies were included for this meta-analysis. The overall prevalence and mortality for increased pancreatic enzymes (>ULN) in COVID-19 were 25.4% (95% CI, 15.8%-36.2%) and 34.6% (95% CI, 25.5%-44.4%), respectively. The overall prevalence and mortality for increased pancreatic enzymes (>3 × ULN) were 6.1% (95% CI, 3.6%-9.2%) and 39.2% (95% CI, 18.7%-61.6%), respectively. Patients with increased pancreatic enzymes, including elevated serum lipase or amylase of either type, had worse clinical outcomes, including need for ICU admission, mechanical ventilation and mortality. DISCUSSION Increased pancreatic enzymes is frequent and may exacerbate the consequences of COVID-19 infection.
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Affiliation(s)
- Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China,Corresponding author.Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yecheng Xu
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yinlei Dong
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yuting Huang
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Yunting Fu
- Health Sciences and Human Services Library, University of Maryland, 601 W Lombard St, Baltimore, MD, 21201, USA
| | - Tian Li
- Department of Medicine, SUNY Downstate Health and Science University, Brooklyn, NY, 11203, USA
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, USA
| | | | - John A. Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand
| | - Deliang Fu
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
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