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Pre-existing pancreatitis was associated with a greater risk for severe outcomes following a COVID-19 diagnosis, a retrospective study found.

In the study of over 325,000 patients with COVID-19, adjusted analyses showed that those with a prior history of pancreatitis had a higher risk for COVID-related hospitalization (OR 1.23, 95% CI 1.12-1.35) and death (HR 1.16, 95% CI 1.02-1.32) compared to those without pancreatitis, Anny H. Xiang, PhD, of Kaiser Permanente Southern California in Pasadena, and colleagues reported in .

And the group found that as pancreatitis progressed, so did the risk of COVID-related hospitalization (P<0.0001 for all):

• Single acute episode: OR 1.16 (95% CI 1.04-1.30)
• Recurrent acute: OR 1.28 (95% CI 1.03-1.58)
• Chronic pancreatitis: OR 1.50 (95% CI 1.21-1.86)

For acute pancreatitis, the higher risk for hospitalization and death were only seen among those who experienced an episode within the last 5 years (OR 1.27 for hospitalization, 95% CI 1.10-1.46; OR 1.25 for death, 95% CI 1.03-1.52). Those with chronic pancreatitis, meanwhile, also had a "borderline significant" greater risk of intensive care unit (ICU) admission (OR 1.50, 95% CI 1.00-2.27).

"Taken together, these results suggest that individuals with more sustained or recent injuries to the pancreas could be at greater risk of developing severe COVID-19," Xiang's group noted.

Prior reports have demonstrated an increased risk of poor outcomes among COVID-19 patients with simultaneous acute pancreatitis, but the current study is the first to examine outcomes for patients with pre-existing pancreatitis among a large, racially and ethnically diverse population, the authors noted.

For their study, the researchers examined electronic medical record data on 326,993 adults from Kaiser Permanente Southern California who had a PCR-confirmed COVID-19 diagnosis from March 2020 to February 2021. This included 4,706 with a history of pancreatitis, as identified by ICD-9/ICD-10 codes: 3,299 single acute episodes, 783 acute recurrent, and 624 with chronic pancreatitis.

For the entire cohort, the mean age was 45, a little over half were women (54%), and the majority were Hispanic (61%). Three-fourths never smoked and half never used alcohol. The pancreatitis group tended to be older (mean age 56), have higher rates of diabetes, and a higher Charlson comorbidity score.

Overall, 5.6% of patients with COVID-19 were hospitalized, 2.1% required intensive respiratory support (IRS), and 1% were admitted to an ICU within 30 days of their COVID-19 diagnosis; and 1.6% died within 60 days of their diagnosis.

Absolute rates of COVID-19 related hospitalization, IRS, ICU admission, and death were two to three times higher for those with versus those without pancreatitis, respectively:

• Hospitalization: 13.4% vs 5.5%
• IRS: 4.7% vs 2.1%
• ICU admission: 2.4% vs 1%
• Death: 5.3% vs 1.6%

In subgroup analyses of patients with pancreatitis, those ages 35 to 64 had a greater hospitalization risk, and those without obesity had a higher risk of hospitalization and death.

The authors acknowledged several limitations to the data, including the lack of data on pancreatitis etiology and pancreatic enzymes to further evaluate disease severity. The group was also unable to assess the effects of COVID-19 vaccination on pancreatitis and severe COVID-19 because of the study's timeframe.

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