2806 Viral-Induced Acute Pancreatitis: A Systematic Review

INTRODUCTION: Infectious (viral, bacterial, and fungal) etiologies are rare causes of acute pancreatitis (AP). We sought to investigate the frequency of viral-induced AP (VIAP), describe its natural course, and clinical features. METHODS: A comprehensive review of PubMed’s database of English language from the time of its inception and until April 12 th ,2019 was performed using all relevant MeSH (medical subject headings) keywords. AP diagnosis and severity were defined as per the Revised Atlanta Classification (RAC). Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities and the attempt to exclude the most common etiologies of AP defined VIAP. Graft pancreatitis studies and non-English publications were excluded. Two independent blinded reviewers (Z.I, C.R.S.L.) reviewed the publications. Bias risk was assessed with the Murad tool derived from the Newcastle-Ottawa scale. RESULTS: 209 cases were identified in 128 publications meeting criteria for VIAP and were reviewed (2 case control, 120 case reports, 6 case series) (Figure 1). Most studies 101 (78.3%) were at high risk of bias. Mean age was 38.9 ± 1.28 yrs for 170 patients. Male to female ratio was 2.2:1, and 52 (28.0%) of 186 patients were immunocompromised. Mean lipase was 1590 (range: 61-16879) and mean amylase was 1237 (range: 33-14800) in 103 and 156 patients. Viral hepatitis (A,B,C,D and E) was the most common virus and accounted for 34.4% of reported cases, followed by coxsackie and echoviruses at 14.8%, hemorrhagic fever viruses at 12.4%, CMV at 12.0%, VZV at 10.5%, mumps and measles at 3.8%, primary HIV infection at 3.8%, HSV at 1.9%, EBV at 1.9% and the remainder of cases (1.9%) attributed to adenovirus, influenza H1N1, and multiple viruses were implicated in 1% of cases. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death was reported in 42 (20.1%) patients. Patient characteristics are summarized in Table 1. CONCLUSION: Although majority of patients were not immunocompromised (72%), a significant portion were immunocompromised (28.0%). Importantly, among those who died, 71.4% were immunocompromised. Mortality rate was higher than that reported for AP from other etiologies in the literature. Cholangiopathy and obstruction, direct acinar injury by viral replication are suggested pathogenesis mechanisms for virus attributed AP.

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