The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion Criteria
2.2. Exclusion Criteria
2.3. Study Design
2.4. Statistical Analysis
3. Results
3.1. Demographic, Clinical and Biological Data of AP Patients from the Pre-COVID-19 vs. during-COVID-19 Group
3.2. Demographic and Biological Data of Pre-COVID-19 AP Patients vs. COVID-19 AP Patients
3.3. Demographic and Biological Data of AP Patients in the during-COVID-19 Period vs. AP Patients with COVID-19
3.4. Comparison of Patients Discharged Alive and Those Who Died in the Pre-COVID-19 Group
3.5. Comparison of Patients Discharged Alive and Those Who Died in the during-COVID-19 Group
3.6. Comparison of Patients with AP and COVID-19 Disease Discharged Alive and Those Who Died
4. Discussion
Study Limitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Primay Results | Secondary Results |
---|---|
| Is there an increased risk of death for patients with AP during the COVID-19 pandemic and, if so, can this be quantified? Did COVID-19 infection have an impact on the clinical outcomes and survival rate of patients with AP? Can COVID-19 infection exacerbate the risk of death in patients with AP and, if so, can this be numerically evaluated? |
Variable | AP Pre-COVID-19 a (n = 56) | AP during-COVID-19 b (n = 56) | AP with COVID-19 c (n = 28) | p a,b | p a–c | p b,c |
---|---|---|---|---|---|---|
Area | 0.705 † | 0.277 † | 0.434 † | |||
Urban | 27 (8.2%) | 25 (46.6%) | 10 (35.7%) | |||
Rural | 29 (51.8%) | 31 (55.4%) | 18 (64.3%) | |||
Age | 49 (38–63) | 50 (44–64) | 49 (41–63) | 0.305 | 0.887 | 0.475 |
Sex | 1 † | 1 † | 1 † | |||
M | 38 (67.9%) | 38 (67.9%) | 19 (67.9%) | |||
W | 18 (32.1%) | 18 (32.1%) | 9 (32.1%) | |||
AP Severity | 1 † | 1 † | 1 † | |||
Mild | 6 (10.7%) | 6 (10.7%) | 3 (10.7%) | |||
Moderately_s | 26 (46.4%) | 26 (46.4%) | 13 (46.4%) | |||
Severe | 24 (42.9%) | 24 (42.9%) | 12 (42.9%) | |||
Hours onset | 24 (12–35) | 36 (24–48) | 24 (12–72) | 0.002 * | 0.161 | 0.785 |
Hospital stay | 12 (8–19) | 9 (7–12) | 9 (7–15) | 0.029 * | 0.110 | 0.696 |
Palpation | 0.064 † | 0.008 *† | 0.462 † | |||
Pain | 30 (53.6%) | 20 (35.7%) | 7 (25.0%) | |||
Tenderness | 14 (25.0%) | 13 (23.2%) | 6 (21.4%) | |||
Guarding | 12 (21.4%) | 23 (41.1%) | 15 (53.6%) | |||
HTN | 0.403 † | 0.306 † | 0.685 † | |||
Yes | 21 (37.5) | 13 (23.2%) | 6 (21.4%) | |||
No | 35 (62.5%) | 43 (76.8%) | 22 (78.6%) | |||
Diabetes | 0.809 † | 0.848 † | 0.723 † | |||
Yes | 11 (19.6%) | 10 (17.9%) | 6 (21.4%) | |||
No | 45 (80.4%) | 46 (82.1%) | 22 (78.6%) | |||
Complications | 0.547 † | 0.746 † | 0.774 † | |||
Yes | 20 (32.15%) | 17 (30.4%) | 9 (32.1%) | |||
No | 36 (64.3%) | 39 (69.6%) | 19 (67.9%) | |||
MSOF | 0.468 † | 0.179 † | 0.380 † | |||
Yes | 8 (14.3%) | 12 (21.4%) | 8 (28.6%) | |||
No | 48 (85.7%) | 44 (78.6%) | 20 (71.4%) | |||
HAPS | 0.541 † | 0.317 † | 0.642 † | |||
0 | 26 (46.4%) | 21 (37.5%) | 8 (28.6%) | |||
1 | 22 (39.3%) | 23 (41.1%) | 12 (42.9%) | |||
2 | 5 (8.9%) | 5 (8.9%) | 5 (17.9%) | |||
3 | 3 (5.4%) | 7 (12.5%) | 3 (10.7%) | |||
Surgery | 0.508 † | 0.264 † | 0.514 † | |||
Yes | 6 (10.7%) | 4 (7.1%) | 1 (3.6%) | |||
No | 50 (89.3%) | 52 (92.9%) | 27 (96.4%) | |||
Mortality | 0.031 *† | <0.001 *† | 0.028 *† | |||
Yes | 4 (7.1%) | 12 (21.4%) | 12 (42.9%) | |||
No | 52 (92.9%) | 44 (78.6%) | 16 (57.1%) |
Variable | AP Pre-COVID-19 a (n = 56) | AP during-COVID-19 b (n = 56) | AP with COVID-19 c (n = 28) | p a,b | p a–c | p b,c |
---|---|---|---|---|---|---|
Leucocytes (×103/µL) | 11.9 (7.2–16.3) | 9.2 (7.6–13.3) | 12.6 (9.4–19.8) | 0.192 | 0.044 * | 0.002 * |
Neutrophile (×103/µL) | 8.2 (11.9–13.8) | 8.0 (5.5–10.2) | 9.1 (6.5–16.1) | 0.658 | 0.133 | 0.021 * |
Lymphocyte (×103/µL) | 1.5 (0.9–2.0) | 1.4 (1.0–2.0) | 2 (1.0–2.5) | 0.658 | 0.220 | 0.074 |
Monocyte (×103/µL) | 0.8 (0.5–1.2) | 0.6 (0.5–0.8) | 0.9 (0.5–1.4) | 0.085 | 0.287 | 0.015 * |
Platelets (×103/µL) | 195.9 (176.4–271.5) | 183.0 (148.0–284.8) | 237.0 (189.0–253.0) | 0.254 | 0.453 | 0.323 |
Hb (g/dL) | 13.6 (12.1–14.5) | 12.5 (11.7–14.5) | 14.0 (10.8–15.9) | 0.073 | 0.790 | 0.414 |
Ht (%) | 38.6 (36.4–44.6) | 38.2 (34.5–43.6) | 35.6 (33.3–43.4) | 0.159 | 0.178 | 0.857 |
RDW | 12.8 (11.1–14.4) | 13.2 (12.4–14.4) | 14 (13.7–14.7) | 0.311 | 0.001 * | 0.004 * |
MCV (fL) | 88.5 (85.2–95.8) | 93.6 (88.7–99.0) | 95.6 (88.4–102.6) | 0.002 * | 0.002 * | 0.362 |
Proteins (g/dL) | 6.5 (6.0–7.2) | 6.0 (5.4–7.0) | 6.4 (5.1–7.3) | 0.001 * | 0.342 | 0.543 |
Amylase (U/L) | 320 (81.3–495.5) | 248.0 (172.0–515.0) | 323.5 (186.0–1114.3) | 1 | 0.288 | 0.384 |
Na (mmol/L) | 134 (129.0–140.0) | 137.6 (131.0–140.0) | 136.5 (132.0–140.0) | 0.218 | 0.565 | 0.610 |
K (mmol/L) | 4.5 (3.8–5.0) | 3.9 (3.7–4.8) | 4.1 (3.5–4.8) | 0.064 | 0.207 | 0.917 |
Glycemia (mg/dL) | 136 (85.0–158.0) | 111 (95.0–212.0) | 99 (93.0–134.8) | 0.691 | 0.102 | 0.035 * |
AST (U/L) | 42 (26.3–110.0) | 88 (37.5–184.0) | 58.0 (33.0–117.0) | 0.019 * | 0.314 | 0.333 |
ALT (U/L) | 48.5 (20.0–172.0) | 87 (52.5–226.5) | 58.0 (24.0–159.0) | 0.001 * | 0.393 | 0.144 |
Urea (mg/dL) | 33 (30.0–49.0) | 32 (24.3–69.0) | 35.5 (26.0–59.0) | 0.550 | 0.932 | 0.930 |
Creatinine (mg/dL) | 0.9 (0.7–1.1) | 0.7 (0.67–1.0) | 0.7 (0.6–1.4) | 0.022 * | 0.305 | 0.887 |
INR | 1.1 (1.1–1.3) | 1.2 (1.0–1.4) | 1.0 (1.0–1.1) | 0.554 | 0.000 * | 0.002 * |
NLR | 6.5 (3.0–12.9) | 5.8 (3.4–12.2) | 5.3 (3.3–11.2) | 0.852 | 0.776 | 0.955 |
IIC | 7.7 (3.2–15.7) | 7.6 (3.9–17.4) | 9.9 (4.2–18.7) | 0.376 | 0.352 | 0.556 |
MCVL | 63.6 (41.5–98.8) | 61.2 (46.3–105.5) | 43.4 (36.9–101.3) | 0.306 | 0.494 | 0.051 |
AP Pre-COVID-19 | AP during-COVID-19 | AP with COVID-19 | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | Alive (n = 52) | Deceased (n = 4) | p | Alive (n = 44) | Deceased (n = 12) | p | Alive (n = 16) | Deceased (n = 12) | p |
Area | 0.266 † | 0.282 † | 0.069 † | ||||||
Urban | 24 (46.2%) | 3 (75%) | 18 (40.9%) | 7 (58.3%) | 8 (50%) | 1 (8.3%) | |||
Rural | 48 (53.8%) | 1 (25%) | 26 (59.1%) | 5 (41.7%) | 8 (50%) | 11 (91.7%) | |||
Age | 46.5 (35–61) | 57 (51–63) | 0.251 | 47 (44–62) | 61 (44–64) | 0.179 | 45.50 (37–61) | 57.5 (42–77) | 0.377 |
Sex | 0.153 † | 0.382 † | 0.129 † | ||||||
M | 34 (65.4%) | 4 (100%) | 29 (65.9%) | 9 (75%) | 9 (56.2%) | 10 (83.3%) | |||
W | 18 (34.6%) | 0 | 15 (34.1%) | 3 (25%) | 7 (43.8%) | 2 (16.7%) | |||
AP Severity | 0.057 † | 0.001 *† | 0.000 *† | ||||||
Mild | 6 (11.5%) | 0 | 6 (13.6%) | 0 | 3 (18.8%) | 0 | |||
Moderately_s | 26 (50%) | 0 | 25 (56.8%) | 1 (8.3%) | 13 (81.2%) | 0 | |||
Severe | 20 (38.5%) | 4 (100%) | 13 (29.5%) | 11 (91.7%) | 0 | 12 (100%) | |||
Hours onset | 24 (12–30) | 39 (6.00–72) | 0.844 | 24 (24–48) | 48 (36–66) | 0.004 * | 12 (12–24) | 71.5 (39–72) | 0.002 * |
Hospital stay | 12 (8–19) | 13.50 (5–22) | 0.798 | 9 (6–10) | 12.5 (9–25) | 0.004 * | 8 (7–10) | 15 (14–32) | 0.003 * |
Palpation | 0.081 † | 0.002 *† | 0.001 *† | ||||||
Pain | 30 (57.7%) | 0 | 20 (45.5%) | 0 | 7 (43.8%) | 0 | |||
Tenderness | 12 (23.1%) | 2 (50%) | 11 (25.0%) | 2 (16.7%) | 0 | 6 (50%) | |||
Guarding | 10 (19.2%) | 2 (50%) | 13 (29.5%) | 10 (83.3%) | 9 (56.2%) | 6 (50%) | |||
HTN | 0.751 † | 1 † | 0.184 † | ||||||
Yes | 17 (32.7%) | 1 (25%) | 11 (25.0%) | 3 (25.0%) | 2 (12.5%) | 4 (33.3%) | |||
No | 35 (67.3%) | 3 (75%) | 33 (75.0%) | 9 (75.0%) | 14 (87.5%) | 8 (66.7%) | |||
Diabetes | 0.113 † | 0.903 † | 0.690 † | ||||||
Yes | 9 (17.3%) | 2 (50%) | 8 (18.2%) | 2 (16.7%) | 3 (18.8%) | 3 (25%) | |||
No | 43 (82.7%) | 2 (50%) | 36 (81.8%) | 10 (83.3%) | 13 (81.2%) | 9 (75%) | |||
Complications | 0.536 † | <0.001 *† | 0.005 *† | ||||||
Yes | 18 (34.6%) | 2 (50%) | 7 (15.9%) | 10 (83.3%) | 2 (12.5%) | 8 (66.7%) | |||
No | 34 (65.4%) | 2 (50%) | 37 (84.1%) | 2 (16.7%) | 14 (87.5%) | 4 (33.3%) | |||
MSOF | 0.001 *† | 0.000 *† | <0.001 *† | ||||||
Yes | 6 (11.5%) | 3 (75%) | 2 (4.5%) | 10 (83.3%) | 2 (12.5%) | 8 (66.7%) | |||
No | 46 (88.5%) | 1 (25%) | 42 (95.5%) | 2 (16.7%) | 14 (87.5%) | 4 (33.3%) | |||
HAPS | 0.000 *† | 0.020 *† | 0.103 † | ||||||
0 | 26 (50%) | 0 | 20 (45.5%) | 1 (8.3%) | 7 (43.8%) | 1 (8.3%) | |||
1 | 20 (38.5%) | 2 (50%) | 18 (40.9%) | 5 (41.7%) | 5 (31.2%) | 7 (58.4%) | |||
2 | 5 (9.6%) | 0 | 3 (6.8%) | 2 (16.7%) | 1 (6.2%) | 4 (33.3%) | |||
3 | 1 (1.9%) | 2 (50%) | 3 (6.8%) | 4 (33.3%) | 3 (18.8%) | 0 | |||
Surgery | 0.472 † | 0.278 † | 0.240 † | ||||||
Yes | 6 (11.5%) | 0 | 4 (9.1%) | 0 | 0 | 1 (8.3%) | |||
No | 46 (88.5%) | 4 (100%) | 40 (90.9%) | 12 (100%) | 16 (100%) | 11 (91.7%) |
AP Pre-COVID-19 | AP during-COVID-19 | AP with COVID-19 | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | Alive N (%) | Deceased N (%) | p | Alive N (%) | Deceased N (%) | p | Alive N (%) | Deceased N (%) | p |
Leucocyte (×103/µL) | 11.7 (7.2–16.3) | 21.4 (16.5–26.0) | 0.005 * | 9.2 (7.5–13.3) | 7.8 (7.1–19.9) | 0.952 | 16.4 (10.2–19.8) | 10.7 (7.7–31.1) | 0.456 |
Neutrophil (×103/µL) | 7.0 (5.2–12.9) | 18.5 (14.0–22.9) | 0.005 * | 8.2 (4.5–10.2) | 6.1 (5.7–17.6) | 0.535 | 9.1 (6.7–16.1) | 9.2 (5.7–27.1) | 0.544 |
Lymfocyte (×103/µL) | 1.6 (0.9–2.2) | 1.1 (1.0–1.1) | 0.372 | 1.6 (1.1–2.0) | 1.0 (0.7–1.0) | 0.000 * | 2.4 (2.0–16.1) | 1.1 (0.9–1.3) | 0.018 * |
Monocyte (×103/µL) | 0.7 (0.5–1.1) | 1.5 (1.5–1.6) | 0.006 * | 0.6 (0.4–0.8) | 0.7 (0.5–1.2) | 0.810 | 1.0 (0.6–1.7) | 0.8 (0.3–1.3) | 0.124 |
Platelet (×103/µL) | 193.6 (170.7–222.8) | 377 (362.0–391.3) | 0.005 * | 191.0 (148.0–284.0) | 148.0 (95.5–299.4) | 0.105 | 237.0 (189.8–287.2) | 207.0 (51.9–249.3) | 0.167 |
Hb (g/dL) | 13.7 (12.2–14.5) | 12.4 (11.3–13.4) | 0.143 | 12.4 (11.7–14.3) | 9.0 (8.5–17.1) | 0.222 | 14.0 (11.2–16.0) | 13.2 (10.1–15.6) | 0.208 |
Ht (%) | 38.6 (36.9–45.0) | 37.1 (34.3–39.8) | 0.339 | 38.6 (35.6–43.3) | 26.4 (25.7–44.3) | 0.271 | 35.6 (34.2–43.4) | 38.7 (29.5–44.2) | 0.327 |
RDW | 12.8 (11.9–13.7) | 14.7 (13.9–23.8) | 0.022 * | 12.5 (11.7–14.3) | 14.9 (12.4–15.6) | 0.254 | 13.8 (13.7–14.0) | 14.7 (14.2–15.2) | 0.004 * |
MCV | 89.1 (85.4–96.3) | 82.4 (79.9–84.9) | 0.011 * | 89.9 (88.3–97.3) | 105.0 (100.1–107.2) | 0.000 * | 90.3 (88.1–93.8) | 102.6 (98.6–102.8) | 0.000 * |
Proteins (g/dL) | 6.6 (6.1–7.2) | 6.1 (5.7–6.5) | 0.097 | 6.0 (5.5–7.3) | 6.3 (5.4–5.6) | 0.457 | 6.9 (6.4–7.4) | 5.1 (4.5–5.12) | 0.000 * |
Amylase (U/L) | 319 (80.5–492.5) | 480.5 (456.0–503.9) | 0.161 | 213.5 (112.8–414.5) | 515.0 (344.0–1196.5) | 0.002 * | 192.0 (186.0–1294.0) | 342.0 (215.0–1144.3) | 0.816 |
Na (mmol/L) | 137.0 (129.0–140.0) | 129.5 (125.0–133.8) | 0.222 | 138.0 (135.2–142.5) | 131.0 (128.0–135.0) | 0.056 | 137.0 (135.0–141.5) | 131.0 (123.0–139.0) | 0.022 * |
K (mmol/L) | 4.5 (3.8–5.0) | 5.1 (4.0–6.1) | 0.315 | 3.9 (3.7–4.5) | 4.8 (3.5–5.2) | 0.475 | 3.9 (3.8–4.2) | 4.2 (3.4–6.9) | 0.133 |
Glycemia (mg/dL) | 136 (84.0–158.0) | 125.5 (95.0–125.5) | 1 | 104.0 (94.3–189.0) | 203.0 (111.0–465.0) | 0.027 | 99.0 (93.0–129.3) | 99.0 (86.8–150.5) | 0.675 |
AST (U/L) | 42.5 (28.8–119.0) | 29.5 (21.0–37.6) | 0.056 | 66.0 (36.0–169.0) | 105.0 (95.0–906.0) | 0.043 * | 40.0 (27.0–102.3) | 90.0 (40.0–372.0) | 0.015 * |
ALT (U/L) | 48.5 (19.0–172.0) | 42.5 (33.0–51.6) | 0.949 | 87.0 (33.0–230.0) | 58.0 (57.5–26.0) | 0.327 | 44.0 (24.0–277.0) | 99.0 (14.3–159.0) | 0.576 |
Urea (mg/dL) | 33.0 (30.0–49.0) | 78.5 (26.0–128.6) | 0.610 | 32.0 (18.5–57.0) | 69.0 (30.0–125.5) | 0.004 * | 31.0 (18.0–52.0) | 59.0 (29.5–182.0) | 0.004 * |
Creatinine (mg/dL) | 0.9 (0.7–1.0) | 2.8 (2.7–4.7) | 0.702 | 0.7 (0.6–0.9) | 4.2 (0.7–6.1) | 0.002 * | 0.7 (0.6–1.2) | 1.7 (0.7–3.3) | 0.032 * |
INR | 1.1 (1.1–1.2) | 6.1 (1.4–10.5) | 0.003 * | 1.1 (0.1–1.4) | 1.4 (0.4–1.6) | 0.001 * | 1.0 (0.9–1.0) | 1.1 (1.0–1.2) | 0.000 * |
NLR | 6.3 (2.6–11.5) | 16.6 (13–21.0) | 0.007 * | 5.1 (2.2–8.5) | 16.4 (6.6–18.0) | 0.000 * | 3.7 (2.6–3.9) | 8.8 (6.9–18.0) | 0.001 * |
IIC | 6.5 (2.8–13.9) | 21.7 (19.3–23.9) | 0.003 * | 6.7 (2.6–14.4) | 22.2 (14.6–27.2) | 0.000 * | 4.6 (36.7–43.4) | 13.9 (11.7–21.3) | 0.002 * |
MCVL | 55.9 (39.9–100.6) | 77.2 (74.6–79.8) | 0.445 | 54.8 (45.4–80.7) | 106.9 (98.6–245.1) | 0.000 * | 37.7 (36.7–43.4) | 96.7 (74.7–112.8) | 0.001 * |
Compared Groups | Odd Ratio CI 95% | Relative Risk (RR) of Death | X2 | Df | p Value |
---|---|---|---|---|---|
AP pre-COVID-19 vs. AP during-COVID-19 | 3.54 (1.06–11.77) | 3.00 (1.03–8.74) | 4.667 | 1 | 0.031 * |
AP pre-COVID-19 vs. AP with COVID-19 | 9.75 (2.75–34.46) | 6.00 (2.12–16.91) | 15.441 | 1 | <0.001 * |
AP during-COVID-19 vs. AP with COVID-19 | 2.75 (1.02–7.35) | 2.00 (1.03–3.86) | 4.200 | 1 | 0.040 * |
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Rădulescu, P.M.; Căluianu, E.I.; Traşcă, E.T.; Mercuţ, D.; Georgescu, I.; Georgescu, E.F.; Ciupeanu-Călugăru, E.D.; Mercuţ, M.F.; Mercuţ, R.; Padureanu, V.; et al. The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic. Diagnostics 2023, 13, 2446. https://doi.org/10.3390/diagnostics13142446
Rădulescu PM, Căluianu EI, Traşcă ET, Mercuţ D, Georgescu I, Georgescu EF, Ciupeanu-Călugăru ED, Mercuţ MF, Mercuţ R, Padureanu V, et al. The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic. Diagnostics. 2023; 13(14):2446. https://doi.org/10.3390/diagnostics13142446
Chicago/Turabian StyleRădulescu, Patricia Mihaela, Elena Irina Căluianu, Emil Tiberius Traşcă, Dorin Mercuţ, Ion Georgescu, Eugen Florin Georgescu, Eleonora Daniela Ciupeanu-Călugăru, Maria Filoftea Mercuţ, Răzvan Mercuţ, Vlad Padureanu, and et al. 2023. "The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic" Diagnostics 13, no. 14: 2446. https://doi.org/10.3390/diagnostics13142446