Serum amylase elevation is associated with adverse clinical outcomes in patients with coronavirus disease 2019.

Ganxun Li,Jia Song,Wei Wang,Bixiang Zhang,Zeyang Ding,Peng Zhu,Chuanhan Zhang,Huifang Liang,Wanguang Zhang,Yuwei Wang,Tongtong Liu,Lin Chen,Tianhong Li,Guannan Jin,Qian Chen,Xiaoping Chen,Junnan Liang

doi:10.18632/aging.203653

Abstract

Objective: Hyperamylasemia was found in a group of patients with COVID-19 during hospitalization. However, the evolution and the clinical significance of hyperamylasemia in COVID-19, is not well characterized.Design: In this retrospective cohort study, the epidemiological, demographic, laboratory, treatment and outcome information of 1,515 COVID-19 patients with available longitudinal amylase records collected from electronic medical system were analyzed to assess the prevalence and clinical significance of hyperamylasemia in this infection. Associated variables with hyperamylasemia in COVID-19 were also analyzed.Results: Of 1,515 patients, 196 (12.9%) developed hyperamylasemia, among whom 19 (1.3%) greater than 3 times upper limit of normal (ULN) and no clinical acute pancreatitis was seen. Multivariable ordered logistic regression implied older age, male, chronic kidney disease, several medications (immunoglobin, systemic corticosteroids, and antifungals), increased creatinine might be associated with hyperamylasemia during hospitalization. Restricted cubic spline analysis indicated hyperamylasemia had a J-shaped association with all-cause mortality and the estimated hazard ratio per standard deviation was 2.85 (2.03-4.00) above ULN. Based on the multivariable mixed-effect cox or logistic regression model taking hospital sites as random effects, elevated serum amylase during hospitalization was identified as an independent risk factor associated with in-hospital death and intensive complications, including sepsis, cardiac injury, acute respiratory distress syndrome, and acute kidney injury.Conclusions: Elevated serum amylase was independently associated with adverse clinical outcomes in COVID-19 patients. Since early intervention might change the outcome, serum amylase should be monitored dynamically during hospitalization.

Highlights

Owing to the emergence of Severe Acute RespiratorySyndrome Coronavirus 2 (SARS-CoV-2), an outbreak of coronavirus disease 2019 (COVID-19) has violently spread almost all over the world
1515 laboratory-confirmed COVID-19 patients were analyzed in this study, among whom 196 presented with serum amylase level elevation, 19 (19/196, 9.7%) greater than 3-fold of upper limit of normal (ULN) (>3ULN; >345 units per liter (U/L)) during hospitalization
According to Revised Atlanta Classification [16, 29], the clinical manifestations and limited available abdominal imaging examinations in our study indicated that no acute pancreatitis diagnosis was established

Summary

Introduction

Owing to the emergence of Severe Acute RespiratorySyndrome Coronavirus 2 (SARS-CoV-2), an outbreak of coronavirus disease 2019 (COVID-19) has violently spread almost all over the world. Owing to the emergence of Severe Acute Respiratory. Carrying significant morbidity and mortality worldwide and posing an enormous threat to human beings, COVID-19 has developed into a global pandemic [1]. Most of the studies lay stress on illustrating respiratory symptoms, common complications, and significant risk factors of severe or deceased cases [7,8,9], while some non-classical but not insignificant morbidities or acute organ injury have been overlooked. Our previous study indicated that a mild elevation of liver chemistries is most commonly found in patients with COVID-19 [10]. A portion of COVID-19 patients with serum amylase level elevation were observed in our clinical practice

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Results

Discussion

Conclusion