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1.
Gastroenterology ; 160(6):S-291-S-292, 2021.
Article in English | EMBASE | ID: covidwho-1594295

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)

2.
American Journal of Gastroenterology ; 116(SUPPL):S598, 2021.
Article in English | EMBASE | ID: covidwho-1534738

ABSTRACT

Introduction: The COVID-19 pandemic has taken the lives of over 3.8 million people worldwide. Recently, multiple publications have suggested that famotidine might be effective in reducing disease severity in the inpatient and outpatient settings. Therefore, we conducted a retrospective analysis of the effects of inpatient, as well as outpatient, use of famotidine and proton pump inhibitors (PPIs) on admitted COVID-19 patients. Methods: COVID-19 positive patients >18-years-old admitted to our tertiary care center between June and August 2020 were included. Those dismissed from the ED were excluded from the study. Univariate and multivariate regression analysis was conducted to determine the effect of famotidine and PPIs on the occurrence of mortality, ICU admission and acute kidney injury (AKI). Patient age, sex, body mass index, and comorbidities (hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD)) were included as covariates. Odds ratios for respective variables were calculated and recorded. Results: 489 patients were included in our study. 43 patients were on PPI therapy on admission. 26 patients were on famotidine on admission. 137 were treated with famotidine while inpatient. On univariate analysis, inpatient famotidine use, age, male sex and DMwere associated with increased mortality (Figure 1Aa). Both inpatient as well as outpatient famotidine use along with male sex were associated with increased ICU admission (Figure 1Ab). Inpatient famotidine use, age, male sex, HTN, DM, CKD and CHF were associated with increased AKI (Figure 1Ac). On multivariate analysis, patient age, male sex and inpatient famotidine were associated with increased mortality (Figure 1Ba). Both inpatient and outpatient famotidine use as well as male sex were associated with increased ICU admission (Figure 1Bb). Inpatient famotidine, male sex, CKD and CHF were associated with increased AKI (Figure 1Bc). PPI use was not associated with changed outcomes in our patient population. Conclusion: While recent publications suggested that famotidine use might be effective in reducing severity of COVID-19 infection, our experience has been to the contrary. It is unclear why the use of famotidine was significantly associated with worse outcomes in our patient population. These findings are consistent with a recent study by Yeramaneni et al. (PMID: 33058865). Further studies with randomized-controlled trials are needed to better evaluate the role of famotidine in COVID-19 patients..

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