Admission serum lipase and ICU mortality in critically ill COVID-19 patients: non-pancreatic hyperlipasemia as a marker of renal and multiorgan dysfunction rather than acute pancreatitis

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Aims: Serum lipase is frequently elevated in critically ill patients, and non-pancreatic hyperlipasemia may be misread as acute pancreatitis. Using a COVID-19 ICU cohort as a model of severe critical illness, we examined whether admission lipase independently predicts ICU mortality and whether lipase elevation corresponds to acute pancreatitis or instead primarily reflects renal and multiorgan dysfunction. Methods: We retrospectively studied 219 adults with RT-PCR-confirmed COVID-19 admitted to a tertiary ICU in 2020. Admission lipase was entered into a predefined multivariable logistic regression for all-cause ICU mortality, adjusted for age, gender, comorbidities, creatinine, PaO₂/FiO₂, LDH, NLR, and troponin. Peak lipase defined the hyperlipasemia phenotype, and acute pancreatitis was diagnosed by the revised Atlanta criteria. Renal function was assessed by CKD-EPI 2021 eGFR. Results: ICU mortality was 54.3%. Hyperlipasemia occurred in 58 patients (26.5%) and marked hyperlipasemia (>201 U/L) in 11, whereas clinically diagnosed acute pancreatitis was identified in only 1 (0.5%). Admission lipase did not discriminate mortality (AUC 0.46; 95% CI 0.39–0.54) and was not an independent predictor (OR 0.88 per 10 U/L; 95% CI 0.73–1.06); older age and lower PaO₂/FiO₂ were the dominant predictors. Hyperlipasemia was more frequent with eGFR

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