The Impact of Chronic Pancreatitis on Outcomes of Patients with COVID-19: A Propensity-Matched Cohort Study

Introduction: Coronavirus disease 2019 (COVID-19) has been a global pandemic. COVID-19 primarily affects the lungs; however, several studies have reported an association between COVID-19 and acute pancreatitis (AP), with some studies reporting an increase in severity of pancreatitis with an adverse impact on morbidity and mortality in patients with COVID-19 and AP. However, the data regarding outcomes of COVID-19 in patients with a history of chronic pancreatitis (CP) is lacking. In our study we aim to investigate COVID-19 related outcomes in CP patients. Methods: We used a large national healthcare research network, including over 106 million patients, sourced from 73 health care organizations located within the United State (US) (TriNetX, a global federated health research network exempts from IRB) and identified all adult patients (aged ≥ 18 years) with COVID-19 infection between January 1, 2020 to January 1, 2023. We compared several COVID-19 related complications in patients with and without CP. We performed 1:1 propensity-score matching for age, gender, race, ethnicity, and all major risk factors of COVID-19 among all cohorts. We assessed COVID-19 outcomes up to 3 months of index date (COVID-19 diagnosis). Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated. Results: General demographics before and after propensity score matching described in Table 1. After propensity score matching, 30-day outcomes showed a significant increase in shock, gastrointestinal hemorrhage, acute respiratory distress syndrome, myocardial ischemia, and increased rate of hospitalization. There was no significant increase in mortality (P= 0.071), Figure 1, panel A. Regarding all-time outcomes data, there was again a significant difference in presence of shock, gastrointestinal hemorrhage, acute respiratory distress syndrome, myocardial ischemia, and increased rate of hospitalization in patients with COVID-19 and CP versus no CP patients. There was also a significant increase in mortality in CP group as compared to patients with COVID-19 and no CP. Figure 1, panel B. Conclusion: Our study is the largest to date to investigate COVID-19 related outcomes in CP patient. We found that CP patients infected with COVID-19 have significantly worse COVID-19 related outcomes compared with COVID-19 patients without CP. Further studies are needed to better understand the exact relationship between COVID-19 and CP.Figure 1.: Outcomes between chronic pancreatitis (CP) and non-chronic pancreatitis (No CP) patients with a positive COVID-19 infection, after propensity score matching. panel A: 30-day outcomes of COVID-19 infection, Panel B: All-time outcomes after COVID-19 infection. VTE; Venous thromboembolism, MI; myocardial infarction, AKI; acute kidney injury, ARDS; acute respiratory distress syndrome, cardiac complications; myocarditis, pericarditis and arrhythmias. Table 1. - Baseline characteristics between chronic pancreatitis (CP) and non-chronic pancreatitis (No CP) patients with a positive COVID-19 infection, before and after propensity score matching Before Matching After Matching Characteristic Name CP No CP P-Value CP No CP P-Value n 10205 3205696 10205 10205 Age 57.67 ± 15.99 47.51 ± 17.79 0 57.67 ± 15.99 57.53 ± 16.47 0.524214 At least 65 years 3699 (36.2%) 644103 (20.1%) 0 3699 (36.2%) 3758 (36.8%) 0.39109 Not Hispanic or Latino 8103 (79.4%) 1789391 (55.8%) 0 8103 (79.4%) 8146 (79.8%) 0.455004 White 7055 (69.1%) 1723000 (53.7%) 0 7055 (69.1%) 7118 (69.8%) 0.338421 Female 5396 (52.9%) 1836763 (57.3%) 1.99E-19 5396 (52.9%) 5373 (52.7%) 0.74709 Male 4809 (47.1%) 1367848 (42.7%) 1.05E-19 4809 (47.1%) 4831 (47.3%) 0.757733 Black or African American 1941 (19.0%) 461548 (14.4%) 3.27E-40 1941 (19.0%) 1914 (18.8%) 0.629205 Unknown Ethnicity 1283 (12.6%) 1162761 (36.3%) 0 1283 (12.6%) 1243 (12.2%) 0.395202 Unknown Race 1006 (9.9%) 943059 (29.4%) 0 1006 (9.9%) 974 (9.5%) 0.449175 Hispanic or Latino 819 (8.0%) 253544 (7.9%) 0.663819 819 (8.0%) 816 (8.0%) 0.93834 Asian 125 (1.2%) 61591 (1.9%) 3.06E-07 125 (1.2%) 145 (1.4%) 0.220465 American Indian or Alaska Native 70 (0.7%) 11782 (0.4%) 1.16E-07 70 (0.7%) 46 (0.5%) 0.025437 Native Hawaiian or Other Pacific Islander 10 (0.1%) 4716 (0.1%) 0.19589 10 (0.1%) 10 (0.1%) 1 Unknown Gender 0 (0.0%) 1085 (0.0%) 0.063055 0 (0.0%) 10 (0.1%) 0.001561 Essential (primary) hypertension 7357 (72.1%) 782538 (24.4%) 0 7357 (72.1%) 7404 (72.6%) 0.462145 Disorders of lipoprotein metabolism and other lipidemias 6219 (60.9%) 712037 (22.2%) 0 6219 (60.9%) 6240 (61.1%) 0.763086 Type 2 diabetes mellitus 5334 (52.3%) 396842 (12.4%) 0 5334 (52.3%) 5359 (52.5%) 0.72605 Overweight and obesity 3999 (39.2%) 528991 (16.5%) 0 3999 (39.2%) 4027 (39.5%) 0.688247 Nicotine dependence 3982 (39.0%) 326964 (10.2%) 0 3982 (39.0%) 3993 (39.1%) 0.874609 Personal history of nicotine dependence 3785 (37.1%) 307271 (9.6%) 0 3785 (37.1%) 3810 (37.3%) 0.717334 Asthma 2769 (27.1%) 312714 (9.8%) 0 2769 (27.1%) 2757 (27.0%) 0.850067 Alcohol related disorders 2767 (27.1%) 102174 (3.2%) 0 2767 (27.1%) 2721 (26.7%) 0.467714 Other chronic obstructive pulmonary disease 2567 (25.2%) 137365 (4.3%) 0 2567 (25.2%) 2539 (24.9%) 0.650895 Body mass index [BMI] 30-39, adult 2148 (21.0%) 246493 (7.7%) 0 2148 (21.0%) 2148 (21.0%) 1 Body mass index [BMI] 40 or greater, adult 922 (9.0%) 133359 (4.2%) 0 922 (9.0%) 920 (9.0%) 0.961034 Hypertensive crisis 633 (6.2%) 26078 (0.8%) 0 633 (6.2%) 609 (6.0%) 0.482229 Secondary hypertension 568 (5.6%) 28806 (0.9%) 0 568 (5.6%) 523 (5.1%) 0.161416 Unspecified maternal hypertension 78 (0.8%) 18809 (0.6%) 0.019068 78 (0.8%) 99 (1.0%) 0.112888 Unspecified pre-existing hypertension complicating pregnancy, childbirth and the puerperium 64 (0.6%) 11887 (0.4%) 2.15E-05 64 (0.6%) 55 (0.5%) 0.407985 Pre-existing essential hypertension complicating pregnancy, childbirth and the puerperium 51 (0.5%) 10309 (0.3%) 0.001518 51 (0.5%) 46 (0.5%) 0.610834 Pre-existing hypertension with pre-eclampsia 33 (0.3%) 3719 (0.1%) 8.98E-10 33 (0.3%) 24 (0.2%) 0.232577 Pre-existing secondary hypertension complicating pregnancy, childbirth and the puerperium 10 (0.1%) 367 (0.0%) 7.49E-16 10 (0.1%) 10 (0.1%) 1 COVID-19 Vaccination (CPT codes) 91300 782 (7.7%) 124384 (3.9%) 0 782 (7.7%) 782 (7.7%) 1 91301 177 (1.7%) 26961 (0.8%) 6.8E-23 177 (1.7%) 191 (1.9%) 0.461445 91305 78 (0.8%) 8100 (0.3%) 1.23E-24 78 (0.8%) 68 (0.7%) 0.40621 91306 49 (0.5%) 10226 (0.3%) 0.003973 49 (0.5%) 44 (0.4%) 0.6033 91303 23 (0.2%) 2616 (0.1%) 4.1E-07 23 (0.2%) 20 (0.2%) 0.646968 91312 14 (0.1%) 1691 (0.1%) 0.000216 14 (0.1%) 11 (0.1%) 0.548261 91313 10 (0.1%) 321 (0.0%) 2.19E-18 10 (0.1%) 10 (0.1%) 1 91302 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91304 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91307 0 (0.0%) 10 (0.0%) 0.858392 0 (0.0%) 0 (0.0%) 91308 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91309 0 (0.0%) 34 (0.0%) 0.742161 0 (0.0%) 0 (0.0%) 91310 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91311 0 (0.0%) 10 (0.0%) 0.858392 0 (0.0%) 0 (0.0%) 91314 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91315 0 (0.0%) 10 (0.0%) 0.858392 0 (0.0%) 0 (0.0%) 91316 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 91317 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)