ABSTRACT
Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical outcomes of mechanical ventilation, intensive care unit (ICU) admission, and mortality. COVID-19 attributed pancreatitis was defined as an episode fulfilling criteria for acute pancreatitis defined earlier, a temporally associated diagnosis of COVID-19 and an exclusion of the most common etiologies of acute pancreatitis (gallstones, alcohol use, class IA/IB/II medication (by Badalov classification) use, endoscopic retrograde pancreatography, or metabolic etiologies (hypercalcemia, hypertriglyceridemia (>1000mg/ dl)). Results Prevalence of hyperlipasemia was 26.6% and of acute pancreatitis 0.33% in 301 patients with COVID-19. Patients with hyperlipasemia were older (p=0.044) and more likely to have chronic kidney disease (p=0.002) (Table 1). A total of 158 (52.5%) of patients reported at least one gastrointestinal symptom (abdominal pain, nausea, vomiting or diarrhea), and the presence of any gastrointestinal symptoms was not associated with the presence of hyperlipasemia (p=0.790). Neither presence of hyperlipasemia or its severity stratified into mild (60-120 U/L), moderate (120-180 U/L), and severe (>180 U/L) categories were associated with increased rates of mechanical ventilation, ICU admission or increased mortality (Table 2). Acute pancreatitis occurred in two patients of which one case was biliary in origin. Prevalence of COVID-19 acute pancreatitis in the reported cohort was 0.33%. Of the other patients with hyperlipasemia, 18 underwent computed tomography of the abdomen and an intra-abdominal process was identified in only two patients, with colitis identified in one patient, and ileus in another. Discussion and Conclusions Acute pancreatitis in COVID-19 patients is rare while hyperlipasemia is common. Hyperlipasemia in patients with COVID-19 is likely attributed to several non-pancreatic etiologies. Both hyperlipasemia in this population, and COVID-19 attributed acute pancreatitis do not appear to have significant impact on patients’ clinical outcomes.(Table presented) (Table presented)
ABSTRACT
INTRODUCTION: Colorectal cancer remains the second leading cause of deaths from cancer in the United States of America. Multiple screening tests are available for early detection of cancer. Several previous studies have suggested that women are less likely to be screened for colorectal cancer compared to men. During the current COVID-19 crisis there was a significant drop in the number of people screened for colon cancer. The impact from delayed screening can have adverse outcomes in colorectal cancer patients. We reviewed our data of our referrals for positive stool FIT-DNA testing before the COVID-19 crisis. METHODS: We prospectively reviewed all cases referred for a positive stool FIT-DNA test to our outpatient endoscopy center from February 2018 to December 2018. A total of 110 patients were included in the study that included 74 females and 36 males. Any patient found not to be at an average risk for colon cancer prior to the stool FIT/DNA test were excluded(e.g. prior history of adenomatous colon polyp or family history of colon cancer). Each patient's findings were collected. All polyps found were recorded with measurements. Biopsies of all the polyps and masses were reviewed and tabulated. Polyps were classified as adenomatous polyp, serrated polyps and hyperplastic polyps. Note was made of any polyps that revealed high grade dysplasia. RESULTS: A surprising finding was noted of more female patients(74 versus 36) being referred for a positive stool FIT/DNA tests. 39 of the 110 patients had at least one of the the following findingsadenomatous polyp at least 10 mm in size, serrated polyp, adenomatous polyp of any size with high grade dysplasia or mass. CONCLUSION: Gender biases exist in colorectal cancer screening test picked by the patients. Although ours is a small study it suggests that females are more likely to accept stool FIT/DNA test. In the current COVID-19 crisis there is a significant hesitation from patients to agree for a screening colonoscopy. A delay in screening can have adverse outcomes in patients with colorectal cancer. A positive stool FIT/DNA test is likely to have patients agree to have a colonoscopy. Despite the false positive rates there is an opportunity to get several advanced adenomas and masses to be picked up earlier in the current COVID-19 crisis during which patients are reluctant to come for a screening colonoscopy.