ABSTRACT
INTRODUCTION: Hypertriglyceridemia is a known complication of propofol infusion, and higher levels of triglycerides are known to be associated with pancreatitis. Patients with severe COVID-19 pneumonia often require prolonged mechanical ventilatory support and often undergo prolonged sedation with medications such as propofol. In our study we looked to identify safe cut offs for triglyceride levels as well as cumulative dosing of propofol in order to minimize the risk of developing pancreatitis. METHOD(S): Utilizing our COVID-19 database from hospitals in the Steward Health Care Network we conducted a retrospective multi-center review to evaluate the instances of pancreatitis in critically ill patients with COVID-19 pneumonia who received propofol for sedation while intubated. We chart reviewed each patient and collected data regarding the number of days over which propofol was administered, cumulative doses of propofol, peak triglyceride levels, lipase levels, symptoms of pancreatitis and abdominal CT imaging consistent with pancreatitis. For the data analysis we used ROC analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and triglyceride levels that would offer maximal sensitivity and specificity for predicting pancreatitis. RESULT(S): We reviewed 499 cases of COVID-19 pneumonia and found 154 patients that were on propofol for sedation for a sufficient period of time. Among these we identified 6 cases of suspected pancreatitis. Using the ROC analysis and Youden's index we identified optimal cut-offs for peak triglyceride levels (688 mg/dl), number of days on propofol (4.5 days), Average daily propofol dose (3007 mg/ day), cumulative propofol dose (24,113 mg) to indicate low risk of pancreatitis. The NPVs for suspected pancreatitis for these cut-offs were found to be from 0.98 to 1. CONCLUSION(S): Our study suggests that patients who have triglyceride levels less than 688 mg/dl, have been on propofol for less than 4.5 days, received less than 3007 mg of propofol per day or have received less than 24113 mg in total of propofol may have a lower risk of developing pancreatitis. While these results are encouraging, larger prospective studies with more confirmed cases of pancreatitis are still necessary.