{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:10:10Z","timestamp":1791544210343,"version":"4.3.4"},"reference-count":102,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Acute pancreatitis (AP) has emerged as a notable complication in patients with COVID-19, yet the interplay between viral infection, systemic inflammation, and pancreatic injury remains incompletely understood. This study aimed to evaluatethe characteristics and risk factors of APin patients with severe COVID-19 pneumonia. We conducted a retrospective, single-center analysis of 405 hospitalized COVID-19 patients with and without AP. Laboratory markers, including CRP, ESR, fibrinogen, LDH, D-dimers, WBC, neutrophils, serum potassium, and serum glucose, alongside imaging and clinical parameters, were analyzed for associations with AP occurrence. Our results indicate that elevated inflammatory and coagulation markers, leukocytosis with neutrophilia, hyperglycemia, hypokalemia, and more severe pulmonary involvement were significantly associated with AP in COVID-19. LDH and inflammatory markers demonstrated particularly strong predictive value, while D-dimers and lung injury severity also contributed to risk stratification. These findings suggest that systemic inflammation, endothelial dysfunction, immunothrombosis, and metabolic impairments converge to increase pancreatic vulnerability in COVID-19 patients. Early recognition of these risk factors may guide monitoring and therapeutic interventions, although prospective validation is needed.<\/jats:p>","DOI":"10.3390\/life15091439","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T07:56:51Z","timestamp":1757923011000},"page":"1439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pancreatic Injury in Severe SARS-CoV-2 Infection: A Retrospective Study Across Three Pandemic Waves"],"prefix":"10.3390","volume":"15","author":[{"given":"Mihai","family":"Lazar","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bals\u201d, No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Emilia","family":"Chitu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9560-6264","authenticated-orcid":false,"given":"Ecaterina Constanta","family":"Barbu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1056\/NEJMcp054958","article-title":"Clinical practice.Acute pancreatitis","volume":"354","author":"Whitcomb","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1053\/j.gastro.2018.02.029","article-title":"Acute Pancreatitis Guideline","volume":"154","author":"Crockett","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_3","first-page":"1326837","article-title":"Viral pancreatitis: Research advances and mechanisms","volume":"14","author":"Yu","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1016\/j.pan.2020.08.018","article-title":"Infectious causes of acute pancreatitis: A systematic review","volume":"20","author":"Imam","year":"2020","journal-title":"Pancreatology"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Panic, N., Mihajlovic, S., Vujasinovic, M., Bulajic, M., and L\u00f6hr, J.-M. (2020). Pancreatitis Associated with Viral Hepatitis: Systematic Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103309"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1007\/s10620-020-06531-9","article-title":"Viral-Attributed Acute Pancreatitis: A Systematic Review","volume":"66","author":"Imam","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_7","first-page":"270","article-title":"The possible role of viral infections in acute pancreatitis: A review of literature","volume":"16","author":"Sarshari","year":"2023","journal-title":"Gastroenterol. Hepatol. Bed Bench"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.bjid.2020.08.011","article-title":"SARS-CoV-2 leading to acute pancreatitis: An unusual presentation","volume":"24","author":"Alves","year":"2020","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1053\/j.gastro.2020.08.044","article-title":"Prevalence, Risk Factors, and Outcomes of Hospitalized Patients with Coronavirus Disease 2019 Presenting as Acute Pancreatitis","volume":"159","author":"Inamdar","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.gastro.2020.03.065","article-title":"Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis","volume":"159","author":"Cheung","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1053\/j.gastro.2020.05.001","article-title":"AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19; Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19","volume":"159","author":"Sultan","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"121","DOI":"10.18683\/germs.2023.1375","article-title":"Clinical, biochemical and pulmonary CT imaging features for hepatobiliary involvement in COVID-19","volume":"13","author":"Dumea","year":"2023","journal-title":"Germs"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lazar, M., Barbu, E.C., Chitu, C.E., Anghel, A.M., Niculae, C.M., Manea, E.D., Damalan, A.C., Bel, A.A., Patrascu, R.E., and Hristea, A. (2022). Pericardial Involvement in Severe COVID-19 Patients. Medicina, 58.","DOI":"10.3390\/medicina58081093"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.cgh.2020.04.040","article-title":"ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection","volume":"18","author":"Liu","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.cmet.2020.11.006","article-title":"SARS-CoV-2 Cell Entry Factors ACE2 and TMPRSS2 Are Expressed in the Microvasculature and Ducts of Human Pancreas but Are Not Enriched in \u03b2 Cells","volume":"32","author":"Coate","year":"2020","journal-title":"Cell Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1053\/j.gastro.2020.03.055","article-title":"Pancreatic Injury Patterns in Patients with Coronavirus Disease 19 Pneumonia","volume":"159","author":"Wang","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.pan.2020.05.003","article-title":"COVID-19 presenting as acute pancreatitis","volume":"20","author":"Aloysius","year":"2020","journal-title":"Pancreatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.pan.2020.04.021","article-title":"Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members","volume":"20","author":"Hadi","year":"2020","journal-title":"Pancreatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1053\/j.gastro.2020.05.069","article-title":"Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2-associated Pancreatitis","volume":"159","author":"Szatmary","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/08941939.2020.1833263","article-title":"Association between Acute Pancreatitis and COVID-19: Could Pancreatitis Be the Missing Piece of the Puzzle about Increased Mortality Rates?","volume":"35","author":"Akarsu","year":"2022","journal-title":"J. Investig. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Anghel, A.M., Niculae, C.M., Manea, E.D., Lazar, M., Popescu, M., Damalan, A.C., Bel, A.A., Nedelcu, I.M., Patrascu, R.E., and Hristea, A. (2022). The Impact of Tocilizumab on Radiological Changes Assessed by Quantitative Chest CT in Severe COVID-19 Patients. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051247"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lazar, M., Barbu, E.C., Chitu, C.E., Buzoianu, M., Petre, A.C., Tiliscan, C., Arama, S.S., Arama, V., Ion, D.A., and Olariu, M.C. (2024). Surviving COVID-19 and Battling Fibrosis: A Retrospective Cohort Study Across Three Pandemic Waves. Diagnostics, 14.","DOI":"10.3390\/diagnostics14242811"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1148\/radiol.2233010680","article-title":"Acute pancreatitis: Assessment of severity with clinical and CT evaluation","volume":"223","author":"Balthazar","year":"2002","journal-title":"Radiology"},{"key":"ref_25","first-page":"e20233559","article-title":"Acute pancreatitis and COVID-19: An integrative review of the literature","volume":"50","author":"Silva","year":"2023","journal-title":"Rev. Col. Bras. Cir."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.hbpd.2023.03.004","article-title":"Prevalence and prognosis of acute pancreatitis in critically ill patients with COVID-19","volume":"22","author":"Kang","year":"2023","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_27","first-page":"208","article-title":"The burden of acute pancreatitis on COVID-19 in the United States","volume":"36","author":"Chaudhry","year":"2023","journal-title":"Ann. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e00215","DOI":"10.14309\/ctg.0000000000000215","article-title":"Marked elevation of lipase in COVID-19 disease: A cohort study","volume":"11","author":"Barlass","year":"2020","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1136\/gutjnl-2020-323364","article-title":"SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study","volume":"70","author":"Pandanaboyana","year":"2021","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1080\/00365521.2021.1896776","article-title":"Acute pancreatitis in COVID-19 patients: True risk?","volume":"56","author":"Bulthuis","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5579795","DOI":"10.1155\/2021\/5579795","article-title":"Clinical Evaluation of Acute Pancreatitis Caused by SARS-CoV-2 Virus Infection","volume":"2021","author":"Vatansev","year":"2021","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"574","DOI":"10.4240\/wjgs.v13.i6.574","article-title":"Acute pancreatitis and COVID-19: A literature review","volume":"13","author":"Soares","year":"2021","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_33","first-page":"11004","article-title":"The pancreas and COVID-19: A clinical conundrum","volume":"13","author":"Goyal","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/s42255-021-00347-1","article-title":"SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas","volume":"3","author":"Conzelmann","year":"2021","journal-title":"Nat. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"110508","DOI":"10.1016\/j.celrep.2022.110508","article-title":"Limited extent and consequences of pancreatic SARS-CoV-2 infection","volume":"38","author":"Jangra","year":"2022","journal-title":"Cell Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1161\/CIRCRESAHA.120.317015","article-title":"Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2","volume":"126","author":"Gheblawi","year":"2020","journal-title":"Circ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1053\/j.gastro.2018.11.082","article-title":"Acute Pancreatitis: A Multifaceted Set of Organelle and Cellular Interactions","volume":"156","author":"Habtezion","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e151551","DOI":"10.1172\/jci.insight.151551","article-title":"SARS-CoV-2 infection of the pancreas promotes thrombofibrosis and is associated with new-onset diabetes","volume":"6","author":"Qadir","year":"2021","journal-title":"JCI Insight"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.cmet.2021.05.013","article-title":"SARS-CoV-2 infects human pancreatic \u03b2 cells and elicits \u03b2 cell impairment","volume":"33","author":"Wu","year":"2021","journal-title":"Cell Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.2337\/db21-0926","article-title":"Indirect and Direct Effects of SARS-CoV-2 on Human Pancreatic Islets","volume":"71","author":"Montefusco","year":"2022","journal-title":"Diabetes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1056\/NEJMra2026131","article-title":"Cytokine Storm","volume":"383","author":"Fajgenbaum","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/s41577-020-0331-4","article-title":"Pathological inflammation in patients with COVID-19: A key role for monocytes and macrophages","volume":"20","author":"Merad","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/s41392-021-00679-0","article-title":"The signal pathways and treatment of cytokine storm in COVID-19","volume":"6","author":"Yang","year":"2021","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Freeman, T.L., and Swartz, T.H. (2020). Targeting the NLRP3 Inflammasome in Severe COVID-19. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01518"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: Consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Papantoniou, K., Aggeletopoulou, I., Michailides, C., Pastras, P., and Triantos, C. (2024). Understanding the Role of NLRP3 Inflammasome in Acute Pancreatitis. Biology, 13.","DOI":"10.3390\/biology13110945"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/jmv.26232","article-title":"The cytokine storm and COVID-19","volume":"93","author":"Hu","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ferrero-Andr\u00e9s, A., Panisello-Rosell\u00f3, A., Rosell\u00f3-Catafau, J., and Folch-Puy, E. (2020). NLRP3 Inflammasome-Mediated Inflammation in Acute Pancreatitis. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21155386"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.cytogfr.2021.06.002","article-title":"The NLRP3 inflammasome and COVID-19: Activation, pathogenesis and therapeutic strategies","volume":"61","author":"Zhao","year":"2021","journal-title":"Cytokine Growth Factor Rev."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Shah, A. (2020). Novel Coronavirus-Induced NLRP3 Inflammasome Activation: A Potential Drug Target in the Treatment of COVID-19. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01021"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"155934","DOI":"10.1016\/j.cyto.2022.155934","article-title":"Inflammasomes and IL-1 family cytokines in SARS-CoV-2 infection: From prognostic marker to therapeutic agent","volume":"157","author":"Declercq","year":"2022","journal-title":"Cytokine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"E289","DOI":"10.1152\/ajpendo.00430.2013","article-title":"Interleukin-1\u03b2 mediates macrophage-induced impairment of insulin signaling in human primary adipocytes","volume":"307","author":"Gao","year":"2014","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Khreefa, Z., Barbier, M.T., Koksal, A.R., Love, G., and Del Valle, L. (2023). Pathogenesis and Mechanisms of SARS-CoV-2 Infection in the Intestine, Liver, and Pancreas. Cells, 12.","DOI":"10.3390\/cells12020262"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5114\/aoms\/178183","article-title":"Interleukins: Pathophysiological role in acute pancreatitis","volume":"20","author":"Rafaqat","year":"2024","journal-title":"Arch Med. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1038\/ajg.2011.307","article-title":"Editorial: Drug-induced acute pancreatitis: Uncommon or commonplace?","volume":"106","author":"Grendell","year":"2011","journal-title":"Am. J. Gastroenterol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/pgmj.69.812.486","article-title":"Pancreatitis associated with diclofenac","volume":"69","author":"Khan","year":"1993","journal-title":"Postgrad. Med. J."},{"key":"ref_57","first-page":"349","article-title":"Drug-induced pancreatitis: A potentially serious and underreported problem","volume":"38","author":"Kaufman","year":"2013","journal-title":"Pharm. Ther."},{"key":"ref_58","first-page":"45","article-title":"Drug-induced acute pancreatitis: A review","volume":"15","author":"Jones","year":"2015","journal-title":"Ochsner J."},{"key":"ref_59","first-page":"e5926","article-title":"Non-steroidal Anti-inflammatory Drug-induced Acute Pancreatitis: A Case Report","volume":"11","author":"Reyes","year":"2019","journal-title":"Cureus"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.3748\/wjg.v26.i22.2902","article-title":"Ever-increasing diversity of drug-induced pancreatitis","volume":"26","author":"Weissman","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Lin, W., Zheng, Q., Wang, X., Lin, X., Ni, X., Pan, J., Zippi, M., Fiorino, S., and Hong, W. (2024). The causality between use of glucocorticoids and risk of pancreatitis: A Mendelian randomization study. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1420840"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40780-019-0134-6","article-title":"Analysis of the Association of Administration of various glucocorticoids with development of acute pancreatitis using US Food and Drug Administration adverse event reporting system (FAERS)","volume":"5","author":"Nango","year":"2019","journal-title":"J. Pharm. Health Care Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1001\/jamainternmed.2013.2737","article-title":"Association of oral glucocorticoid use with an increased risk of acute pancreatitis: A population-based nested case-control study","volume":"173","author":"Mattsson","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"6806","DOI":"10.3748\/wjg.v12.i42.6806","article-title":"Dexamethasone mediates protection against acute pancreatitis via upregulation of pancreatitis-associated proteins","volume":"12","author":"Kandil","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"RECOVERY Collaborative Group, Horby, P., Lim, W.S., Emberson, J.R., Mafham, M., Bell, J.L., Linsell, L., Staplin, N., Brightling, C., and Ustianowski, A. (2021). Dexamethasone in Hospitalized Patients with COVID-19. N. Engl. J. Med., 384, 693\u2013704.","DOI":"10.1056\/NEJMoa2021436"},{"key":"ref_66","first-page":"1139","article-title":"An overview of bone disease in HIV-infected patients","volume":"31","author":"Barbu","year":"2015","journal-title":"Acta Medica Mediterr."},{"key":"ref_67","first-page":"114","article-title":"Evaluation of bone mineral density and correlations with inflammation markers in romanianhiv-positive patients undergoing combined antiretroviral therapy","volume":"65","author":"Munteanu","year":"2017","journal-title":"Farmacia"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"323","DOI":"10.15403\/jgld.2014.1121.253.hpc","article-title":"Body Composition Changes in Patients with Chronic Hepatitis C","volume":"25","author":"Barbu","year":"2016","journal-title":"J. Gastrointest. Liver Dis. JGLD"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Qian, F.H., Cao, Y., Liu, Y.X., Huang, J., and Zhu, R.H. (2024). A predictive model to explore risk factors for severe COVID-19. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-68946-y"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Ding, P., Song, B., Liu, X., Fang, X., Cai, H., Zhang, D., and Zheng, X. (2021). Elevated Pancreatic Enzymes in ICU Patients with COVID-19 in Wuhan, China: A Retrospective Study. Front. Med., 8.","DOI":"10.3389\/fmed.2021.663646"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e59209","DOI":"10.7554\/eLife.59209","article-title":"Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC)","volume":"9","author":"Pawlowski","year":"2020","journal-title":"eLife"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Huang, Y., Guo, L., Chen, J., Wu, M., Zhang, C., Liu, Z., Li, J., Li, K., Xiong, Z., and Wu, Q. (2022). Serum Lactate Dehydrogenase Level as a Prognostic Factor for COVID-19: A Retrospective Study Based on a Large Sample Size. Front. Med., 8.","DOI":"10.3389\/fmed.2021.671667"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.pan.2021.02.021","article-title":"Hyperlipasemia in absence of acute pancreatitis is associated with elevated D-dimer and adverse outcomes in COVID 19 disease","volume":"21","author":"Ahmed","year":"2021","journal-title":"Pancreatology"},{"key":"ref_74","first-page":"e34894","article-title":"Retrospective Observational Study of Complete Blood Count (CBC) Parameters and ICU Mortality of COVID-19 Disease in Delta Variant and Omicron Variant in a Community-Based Hospital in New York City","volume":"15","author":"Yadav","year":"2023","journal-title":"Cureus"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Wan, J., Yang, X., He, W., Zhu, Y., Zhu, Y., Zeng, H., Liu, P., Xia, L., and Lu, N. (2019). Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-0989-x"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00006676-200303000-00003","article-title":"Coagulative disorders in human acute pancreatitis: Role for the D-dimer","volume":"26","author":"Salomone","year":"2003","journal-title":"Pancreas"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Li, L., Tan, Q., Wu, X., Mou, X., Lin, Z., Liu, T., Huang, W., Deng, L., Jin, T., and Xia, Q. (2024). Coagulopathy and acute pancreatitis:Pathophysiology and clinical treatment. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1477160"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1161\/CIRCRESAHA.120.317447","article-title":"The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications","volume":"127","author":"McFadyen","year":"2020","journal-title":"Circ. Res."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Poudel, A., Poudel, Y., Adhikari, A., Aryal, B.B., Dangol, D., Bajracharya, T., Maharjan, A., and Gautam, R. (2021). D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256744"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1016\/j.jacc.2020.04.031","article-title":"COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review","volume":"75","author":"Bikdeli","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Bunch, C.M., Moore, E.E., Moore, H.B., Neal, M.D., Thomas, A.V., Zackariya, N., Zhao, J., Zackariya, S., Brenner, T.J., and Berquist, M. (2022). Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.889999"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1053\/j.gastro.2015.08.026","article-title":"Neutrophil Extracellular Traps Induce Trypsin Activation, Inflammation, and Tissue Damage in Mice with Severe Acute Pancreatitis","volume":"149","author":"Merza","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_83","first-page":"e138999","article-title":"Neutrophil extracellular traps in COVID-19","volume":"5","author":"Zuo","year":"2020","journal-title":"JCI Insight"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Tuculeanu, G., Barbu, E.C., Lazar, M., Chitu-Tisu, C.E., Moisa, E., Negoita, S.I., and Ion, D.A. (2023). Coagulation Disorders in Sepsis and COVID-19\u2014Two Sides of the Same Coin? A Review of Inflammation\u2014Coagulation Crosstalk in Bacterial Sepsis and COVID-19. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020601"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Murthy, P., Singhi, A.D., Ross, M.A., Loughran, P., Paragomi, P., Papachristou, G.I., Whitcomb, D.C., Zureikat, A.H., Lotze, M.T., and Zeh Iii, H.J. (2019). Enhanced Neutrophil Extracellular Trap Formation in Acute Pancreatitis Contributes to Disease Severity and Is Reduced by Chloroquine. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.00028"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Cho, S.K., Jung, S., Lee, K.J., and Kim, J.W. (2018). Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol., 18.","DOI":"10.1186\/s12876-018-0748-4"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"45","DOI":"10.21037\/tgh-21-21","article-title":"Could immune activation cause pancreatitis in COVID-19 patients?","volume":"7","author":"Alberca","year":"2022","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1053\/j.gastro.2020.07.014","article-title":"Lipotoxicity and Cytokine Storm in Severe Acute Pancreatitis and COVID-19","volume":"159","author":"Hegyi","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.amjsurg.2008.04.011","article-title":"Ischemic acute pancreatitis: Clinical features of 11 patients and review of the literature","volume":"197","author":"Hackert","year":"2009","journal-title":"Am. J. Surg."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s10157-020-01996-4","article-title":"Hypokalemia in Patients with COVID-19","volume":"25","author":"Alfano","year":"2021","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e2011122","DOI":"10.1001\/jamanetworkopen.2020.11122","article-title":"Assessment of Hypokalemia and Clinical Characteristics in Patients with Coronavirus Disease 2019 in Wenzhou, China","volume":"3","author":"Chen","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-019-0247-0","article-title":"2019 WSES guidelines for the management of severe acute pancreatitis","volume":"14","author":"Tolonen","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41575-020-00389-y","article-title":"COVID-19 and acute pancreatitis: Examining the causality","volume":"18","author":"Capurso","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1016\/j.cmet.2021.09.009","article-title":"Hyperglycemia in acute COVID-19 is characterized by insulin resistance and adipose tissue infectivity by SARS-CoV-2","volume":"33","author":"Reiterer","year":"2021","journal-title":"Cell Metab."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Zhu, P., Wang, X., Hu, C., Zhang, X., Lin, Z., Jin, T., Li, L., Shi, N., Yang, X., and Huang, W. (2025). The Stress Hyperglycemia Ratio as a Predictor of Clinical Outcomes in Acute Pancreatitis: A Retrospective Cohort Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144970"},{"key":"ref_96","first-page":"e37487","article-title":"A Review of Hyperglycemia in COVID-19","volume":"15","author":"Zahedi","year":"2023","journal-title":"Cureus"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Balaban, M., Balaban, D.V., Enache, I., Nedelcu, I.C., Jinga, M., and Gheorghe, C. (2024). Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis. Medicina, 60.","DOI":"10.3390\/medicina60060856"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1056\/NEJMoa2015432","article-title":"Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in COVID-19","volume":"383","author":"Ackermann","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/bjs.5316","article-title":"Disturbances of the microcirculation in acute pancreatitis","volume":"93","author":"Cuthbertson","year":"2006","journal-title":"Br. J. Surg."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Kotan, R., Peto, K., Deak, A., Szentkereszty, Z., and Nemeth, N. (2023). Hemorheological and Microcirculatory Relations of Acute Pancreatitis. Metabolites, 13.","DOI":"10.3390\/metabo13010004"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1007\/s00134-004-2363-9","article-title":"Ventilator-induced lung injury and multiple system organ failure: A critical review of facts and hypotheses","volume":"30","author":"Slutsky","year":"2004","journal-title":"Intensive Care Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.4187\/respcare.02992","article-title":"Spillover of cytokines and reactive oxygen species in ventilator-induced lung injury associated with inflammation and apoptosis in distal organs","volume":"59","author":"Liu","year":"2014","journal-title":"Respir. 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