Goal: 

We aim to perform a multicenter retrospective cohort study to determine if elevated serum lipase determines clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Background: 

Several cases of acute pancreatitis (AP) have recently been reported in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Most of the evidence is based on elevated serum lipase values without objective demonstration of pancreatic inflammation or necrosis.

Materials and Methods: 

A population-based, multicenter, retrospective cohort study utilizing TriNetX was performed to obtain aggregated health records of ∼69 million patients from 49 health care organizations from January 1, 2020, to December 31, 2020. Adult patients (18 y and above) diagnosed with COVID-19 were identified using appropriate International Classification of Diseases, 10th Revision (ICD-10) codes and were stratified into 2 groups, with elevated (≥180 U/L) and with normal (≤80 U/L) serum lipase. The primary outcome was 30-day mortality; other outcomes were 30-day rehospitalization, need for mechanical ventilation, need for vasopressor use, acute kidney injury.

Results: 

A total of 435,731 adult patients with COVID-19 were identified, and 1406 of them had elevated serum lipase which was associated with higher 30-day mortality [risk ratio (RR)=1.53, P<0.001], risk of acute kidney injury (RR=1.5, P=0.003), and vasopressor use (RR=1.69, P<0.001) without any difference in 30-day rehospitalization (RR=0.98, P=0.54), or need for mechanical ventilation (RR=1.20, P=0.26). The negative predictive value of normal serum lipase for 3-month mortality in patients with COVID-19 was 91%.

Conclusions: 

Patients with COVID-19 who have elevated serum lipase experience worse clinical outcomes even in the absence of AP. If these findings can be replicated in prospective studies, serum lipase can be utilized as a marker of disease severity in patients with COVID-19.

中文翻译：

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高脂肪酶血症是否预示着 COVID-19 的临床结果会更差？多中心回顾性队列研究

目标： 

我们的目标是进行一项多中心回顾性队列研究，以确定血清脂肪酶升高是否决定 2019 年冠状病毒病 (COVID-19) 患者的临床结果。

背景： 

最近报道了几例与严重急性呼吸综合征冠状病毒 2 ( SARS-CoV-2 ) 感染相关的急性胰腺炎 (AP) 病例。大多数证据基于血清脂肪酶值升高，没有客观证明胰腺炎症或坏死。

材料和方法： 

利用 TriNetX 进行了一项基于人群的多中心回顾性队列研究，获取了 2020 年 1 月 1 日至 2020 年 12 月 31 日期间来自 49 个医疗保健组织的约 6900 万名患者的汇总健康记录。成年患者（18 岁及以上）被诊断为使用适当的国际疾病分类第 10 版(ICD-10) 代码对感染 COVID-19 的患者进行识别，并将其分为 2 组：血清脂肪酶升高 (≥180 U/L) 和正常 (≤80 U/L)。主要结局是 30 天死亡率；其他结局包括 30 天再次住院、需要机械通气、需要使用血管加压药、急性肾损伤。

结果： 

总共确定了 435,731 名成年 COVID-19 患者，其中 1406 名患者的血清脂肪酶升高，这与较高的 30 天死亡率相关[风险比 (RR)=1.53，P <0.001]、急性肾损伤的风险（ RR=1.5，P =0.003）和使用血管加压药（RR=1.69，P <0.001）在 30 天再住院（RR=0.98，P =0.54）或需要机械通气（RR=1.20，P）方面没有任何差异=0.26）。正常血清脂肪酶对 COVID-19 患者 3 个月死亡率的阴性预测值为 91%。

结论： 

即使没有 AP，血清脂肪酶升高的 COVID-19 患者的临床结果也会较差。如果这些发现可以在前瞻性研究中得到重复，那么血清脂肪酶可以用作 COVID-19 患者疾病严重程度的标志物。