Impact of coronavirus disease 2019 on the clinical outcomes of acute pancreatitis: a nationwide observational study in Japan

Abstract

Background/objectives

Acute pancreatitis (AP) is a major gastrointestinal disorder with an increasing global incidence. However, the impact of coronavirus disease 2019 (COVID-19) on AP remains unclear, particularly in Japan. This study aimed to investigate the association between AP and COVID-19, including the influence of comorbidities, using a Japanese nationwide administrative database.

Methods

We retrospectively analyzed patients with AP who were hospitalized between April 2020 and March 2023, registered in the Diagnosis Procedure Combination database. Patients were classified into COVID-19-negative and COVID-19-positive groups. Propensity score matching was performed to adjust for potential confounders in the analysis of factors associated with severe AP.

Results

Among 65,770 patients with AP, 548 (0.8 %) were COVID-19-positive, with COVID-19 recorded as a comorbidity at admission in 345 patients and as a secondary diagnosis during hospitalization in 203 patients. Compared with the COVID-19-negative group, the COVID-19-positive group had a higher proportion of severe AP (42.0 % vs. 30.2 %), intensive care unit admissions (4.6 % vs. 2.7 %), mechanical ventilation (5.5 % vs. 2.5 %), interventions for local complications (3.3 % vs. 1.8 %), and in-hospital mortality (5.0 % vs. 2.5 %). After propensity score matching, COVID-19 positivity and renal disease were associated with severe AP. When stratified by the timing of COVID-19 diagnosis, patients diagnosed during hospitalization were older, had longer hospital stays, and experienced higher in-hospital mortality compared with those without COVID-19 or those diagnosed at admission.

Conclusions

Patients with concurrent COVID-19 infection, particularly those diagnosed during hospitalization, are at increased risk of severe AP and in-hospital mortality compared to those without COVID-19.