CHRONIC PANCREATITIS AND COVID-19: INCIDENCE AND OUTCOMES. A MULTICENTER RESEARCH NETWORK ANALYSIS

ABSTRACT

Introduction: SARS-CoV-2, the causative organism for COVID-19, uses ACE2 to enter human cells. Pancreatic ductal, acinar and islet cells also express ACE-2;therefore, involvement of the pancreas is plausible. Elevated lipase and cases of acute pancreatitis related to COVID-19 have been reported in previous studies. Patients with chronic pancreatitis (CP) have a low-grade inflammatory state and pancreatic parenchymal fibrosis, which may predispose them to pancreatic injury and worse COVID-19 outcomes. However, large studies reporting the incidence and outcomes of COVID-19 in patients with chronic pancreatitis are lacking. Methods: A retrospective cohort study was performed using TriNetX (a multiinstitutional research network). Prevalence and Incidence Rate Ratio (IRR) (cases/ personday) of COVID-19 were charted for patients with CP between January 2020 and July 2021. Patients diagnosed with COVID-19 during this period were stratified into two groups based on the presence of CP (CP cohort and non-CP cohort). Outcomes of COVID-19 in the CP cohort were compared to the non-CP cohort after 11 propensity score matching (PSM) for age, gender, race, diabetes, ischemic heart disease, hypertension, lung disease, cirrhosis, smoking, and alcohol abuse. Results: A total of 4420 patients with CP diagnosed with COVID-19 were identified and compared to 1,169,773 patients without CP. A large proportion of patients with CP were diagnosed with COVID-19 and the IRR peaked between December 2020-January 2021 and then declined subsequently (Figure 1). Patients in the CP cohort were older and had a higher prevalence of multiple comorbidities (Table 1). In crude, unmatched analysis, COVID-19 patients with CP had higher mortality (4.96% vs 2.16%;RR 2.29, 95% CI2.02-2.61), need for hospitalization (RR 3.64, 95% CI3.47-3.83), critical care need (RR 3.16, 95% CI2.86-3.50), and acute kidney injury (AKI) (RR 3.96, 95% CI3.71-4.24) compared to patients without CP (Table 1). No residual imbalance was noted (SMD <0.1 for all covariates) after PSM. After PSM, no difference in mortality or rate of mechanical ventilation was noted, however, patients with CP had a significantly higher risk of hospitalizations (RR 1.51, 95% CI1.39-1.64) and AKI (RR 1.28, 95% CI1.16-1.42) (Table 1). No difference in mortality, hospitalization, and critical care was noted for patients with alcohol-induced CP vs other etiologies. Conclusion: Patients with CP have high mortality and risk of poor outcomes after COVID-19 due to the presence of a significant burden of comorbidities and risk factors for severe COVID-19. In addition, CP is independently associated with higher healthcare utilization and complications such as AKI in patients with COVID-19. (Figure Presented) Figure 1 Prevalence and Incidence rate (cases/person-day) of COVID-19 in patients with chronic pancreatitis (Table Presented) Table 1. Characteristics and outcomes of patients with COVID-19 in matched and unmatched Chronic Pancreatitis (CP) and non-CP cohorts