Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal
BACKGROUND: Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports o...
| Main Authors: | , , , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2023
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| Online Access: | https://hdl.handle.net/10356/169326 |
| _version_ | 1826111420387819520 |
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| author | Teng, Thomas Zheng Jie Chua, Branden Qi Yu Lim, Puay Khim Chan, Kai Siang Shelat, Vishal G. |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Teng, Thomas Zheng Jie Chua, Branden Qi Yu Lim, Puay Khim Chan, Kai Siang Shelat, Vishal G. |
| author_sort | Teng, Thomas Zheng Jie |
| collection | NTU |
| description | BACKGROUND: Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP. AIM: To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system. METHODS: A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause. RESULTS: The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP. CONCLUSION: Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology. |
| first_indexed | 2024-10-01T02:50:25Z |
| format | Journal Article |
| id | ntu-10356/169326 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T02:50:25Z |
| publishDate | 2023 |
| record_format | dspace |
| spelling | ntu-10356/1693262023-07-16T15:37:52Z Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal Teng, Thomas Zheng Jie Chua, Branden Qi Yu Lim, Puay Khim Chan, Kai Siang Shelat, Vishal G. Lee Kong Chian School of Medicine (LKCMedicine) Tan Tock Seng Hospital Science::Medicine COVID-19 Pancreatic Diseases BACKGROUND: Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP. AIM: To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system. METHODS: A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause. RESULTS: The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP. CONCLUSION: Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology. Published version 2023-07-12T08:12:04Z 2023-07-12T08:12:04Z 2023 Journal Article Teng, T. Z. J., Chua, B. Q. Y., Lim, P. K., Chan, K. S. & Shelat, V. G. (2023). Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal. World Journal of Gastroenterology, 29(13), 2050-2063. https://dx.doi.org/10.3748/wjg.v29.i13.2050 1007-9327 https://hdl.handle.net/10356/169326 10.3748/wjg.v29.i13.2050 37155526 13 29 2050 2063 en World Journal of Gastroenterology ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ application/pdf |
| spellingShingle | Science::Medicine COVID-19 Pancreatic Diseases Teng, Thomas Zheng Jie Chua, Branden Qi Yu Lim, Puay Khim Chan, Kai Siang Shelat, Vishal G. Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title | Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title_full | Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title_fullStr | Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title_full_unstemmed | Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title_short | Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: a modified Naranjo score appraisal |
| title_sort | occam s razor or hickam s dictum covid 19 is not a textbook aetiology of acute pancreatitis a modified naranjo score appraisal |
| topic | Science::Medicine COVID-19 Pancreatic Diseases |
| url | https://hdl.handle.net/10356/169326 |
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