Hyperamylasemia in COVID-19 patients: pancreatic involvement or secondary epiphenomenon?

Marcello Candelli^{1

2}, Roberta Calce³, Giulia Pignataro⁴, Simona Racco⁵, Mariella Fuorlo⁵, Fabiana Barone, Andrea Piccioni⁵, Giuseppe Merra⁶, Veronica Ojetti⁷, Antonio Gasbarrini^{3

8}, Francesco Franceschi^{5

8}

Affiliations

¹ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy. marcello.candelli@policlinicogemelli.it.
² Translational Medicine and Surgery Department, Medicine and Surgery Faculty of Rome, Università Cattolica del Sacro Cuore di Milano, Rome, Italy. marcello.candelli@policlinicogemelli.it.
³ Medical, Abdominal Surgery and Endocrine-Metabolic Science Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy.
⁴ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy. giulia.pignataro@policlinicogemelli.it.
⁵ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy.
⁶ Biomedicine and Prevention Department, Section of Clinical Nutrition and Nutrigenomics, Facoltà di Medicina e Chirurgia, Università degli Studi di Roma Tor Vergata, 00133, Rome, Italy.
⁷ Department of Internal Medicine, UniCamillus International Medical University of Rome, 00131, Rome, Italy.
⁸ Translational Medicine and Surgery Department, Medicine and Surgery Faculty of Rome, Università Cattolica del Sacro Cuore di Milano, Rome, Italy.

PMID: 40836178
DOI: 10.1007/s11739-025-04087-y

Hyperamylasemia in COVID-19 patients: pancreatic involvement or secondary epiphenomenon?

Marcello Candelli et al. Intern Emerg Med. 2025.

. 2025 Aug 20.

doi: 10.1007/s11739-025-04087-y. Online ahead of print.

Authors

Affiliations

¹ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy. marcello.candelli@policlinicogemelli.it.
² Translational Medicine and Surgery Department, Medicine and Surgery Faculty of Rome, Università Cattolica del Sacro Cuore di Milano, Rome, Italy. marcello.candelli@policlinicogemelli.it.
³ Medical, Abdominal Surgery and Endocrine-Metabolic Science Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy.
⁴ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy. giulia.pignataro@policlinicogemelli.it.
⁵ Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168, Rome, Italy.
⁶ Biomedicine and Prevention Department, Section of Clinical Nutrition and Nutrigenomics, Facoltà di Medicina e Chirurgia, Università degli Studi di Roma Tor Vergata, 00133, Rome, Italy.
⁷ Department of Internal Medicine, UniCamillus International Medical University of Rome, 00131, Rome, Italy.
⁸ Translational Medicine and Surgery Department, Medicine and Surgery Faculty of Rome, Università Cattolica del Sacro Cuore di Milano, Rome, Italy.

PMID: 40836178
DOI: 10.1007/s11739-025-04087-y

Abstract

Elevated serum amylase has been frequently observed in COVID-19 patients, but whether hyperamylasemia results from a direct or indirect pancreatic effect or other mechanisms remains debated. Our study aimed to investigate the association between hyperamylasemia, pancreatitis, and COVID-19 severity. We retrospectively analyzed 1858 patients who visited the emergency department of Fondazione Policlinico Gemelli-IRCCS in Rome during the first two years of the pandemic. All had a confirmed COVID-19 diagnosis and underwent serum amylase evaluation. Clinical and laboratory data, including oxygen therapy requirements, intensive care unit (ICU) admission, and mortality, were extracted from electronic medical records. Univariate analysis revealed a correlation between hyperamylasemia and blood urea nitrogen, ICU admission, multiple comorbidities, and D-dimer levels. Multivariable logistic regression, adjusted for age, sex, comorbidities, and blood urea nitrogen, confirmed that ICU admission-but not in-hospital mortality-was independently associated with hyperamylasemia. Acute pancreatitis was diagnosed in only four patients. Elevated serum amylase levels appear more related to disease severity than direct pancreatic involvement. Emergency physicians should recognize that hyperamylasemia detected upon emergency department admission in COVID-19 patients may indicate an increased risk of ICU admission rather than acute pancreatitis, warranting closer evaluation and management.

Keywords: COVID-19; Hyperamylasemia; ICU; Pancreas; SARS-CoV-2; Severity.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interest: The authors declare that they have no conflict of interest. Ethical approval: The study was carried out in compliance with the Helsinki Declaration, and the local ethics committee of the Catholic University of the Sacred Heart of Rome approved the study protocol (ID: 4916 Protocol number 0014840/2022). Informed consent: For the retrospective nature of the study, the absence of risk for the patients, the use of medical records, the high number of patients involved and the anonymization of the data used the etical committee waived the collection of informed consent from partecipant on the basis of the rules of the Italian data protection autority.

References

1. Ochani R, Asad A, Yasmin F, Shaikh S, Khalid H, Batra S et al (2021) COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med 29:20–36 - PubMed
1. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S et al (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 181:271–280. https://doi.org/10.1016/j.cell.2020.02.052 - DOI - PubMed - PMC
1. Chung YS, Lam CY, Tan PH, Tsang HF, Wong SC (2024) Comprehensive review of COVID-19: epidemiology, pathogenesis, advancement in diagnostic and detection techniques, and post-pandemic treatment strategies. Int J Mol Sci 25:8155. https://doi.org/10.3390/ijms25158155 - DOI - PubMed - PMC
1. Minassie BB, Degu WA, Etissa EK, Asfeha NF, Alemayehu ST, Huluka DK (2025) Attributes and factors associated with long covid in patients hospitalized for acute COVID-19: a retrospective cohort study. PLoS ONE 16(20):e0317512
1. Dutch COVID & Thrombosis Coalition, Kaptein FHJ, Stals MAM, Grootenboers M, Braken SJE, Burggraaf JLI, van Bussel BCT et al (2021) Incidence of thrombotic complications and overall survival in hospitalized patients with COVID-19 in the second and first wave. Thromb Res 199:143–148

LinkOut - more resources

Full Text Sources
- Springer
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Hyperamylasemia in COVID-19 patients: pancreatic involvement or secondary epiphenomenon?

Affiliations

Hyperamylasemia in COVID-19 patients: pancreatic involvement or secondary epiphenomenon?

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources

Miscellaneous