Incidence, outcomes, and impact of COVID‐19 on inflammatory bowel disease: propensity matched research network analysis

Abstract

Background: Accurate estimates for the risk of COVID-19 in IBD, and an understanding of the impact of COVID-19 on IBD course and the risk of incident post-infectious IBD are needed. Aims: To estimate the risk of COVID-19 in IBD and study its impact on IBD course and the risk of incident post-infectious IBD. Methods: A retrospective propensity score matched cohort study utilising multiinstitutional research network TriNetX. COVID-19 patients with and without IBD were identified to quantify the risk of COVID-19 in patients with IBD, COVID-19 outcomes in patients with IBD and the impact of COVID-19 on IBD disease course. The risk of incident post-infectious IBD in COVID-19 patients was compared to the population not infected with COVID-19 during a similar time period.Results: Incidence rate ratio for COVID-19 was lower in IBD patients compared to the non-IBD population (0.79, 95% CI: 0.72-0.86). COVID-19-infected patients with IBD were at increased risk for requiring hospitalisation compared to non-IBD population (RR: 1.17, 95% CI: 1.02-1.34) with no differences in need for mechanical ventilation or mortality. Patients with IBD on steroids were at an increased risk for critical care need (RR: 2.22, 95% CI: 1.29-3.82). Up to 7% of patients with IBD infected with COVID-19 suffered an IBD flare 3-months post-infection. Risk for incident IBD post-COVID was lower than that seen in the non-COVID population (RR: 0.64, 95% CI: 0.54-0.65). Conclusion:We observed no increase in risk for COVID-19 amongst patients with IBD or risk for de novo IBD after COVID-19 infection. We confirmed prior observations regarding the impact of steroid use on COVID-19 severity in patients with IBD.

Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

“…Similar trends were observed across Europe, and in one cohort study in Denmark, the prevalence was lower in patients with IBD than the general population (2.5% vs 3.7%, p<0.01) 25. Worldwide, the reported period prevalence of COVID-19 up until early-2022 among patients with IBD ranged from 0% to 5.95% 24–29…”

“…One retrospective cohort, conducted early in the pandemic, reported no increased risk of hospitalisation in patients with IBD (RR 1.10, 95% CI 0.74 to 1.40) 40. Conversely, two large-scale studies from the Netherlands and USA reported higher rates by 17%–68% in patients with IBD 24 41. In these studies, however, clinical course in hospitalised patients was similar to those not hospitalised, reflecting intercountry variation in threshold for hospital admission.…”

“…Two large registry studies across the USA confirmed that the overall incidence rate of COVID-19 among patients with IBD was low (0.23%), and similar to those without IBD 23. Some data from the USA even suggested that patients with IBD had a lower risk of COVID-19 compared with non-IBD cohorts (risk ratio (RR) 0.79, 95% CI 0.72 to 0.86), however, this may be explained by the phenomenon known as ‘shielding’ as some governments advised patients with IBD, who were thought to be at higher risk of severe COVID-19, to stay at home and minimise face-to-face contacts 24. Similar trends were observed across Europe, and in one cohort study in Denmark, the prevalence was lower in patients with IBD than the general population (2.5% vs 3.7%, p<0.01) 25.…”

Letter: association between COVID‐19 and inflammatory bowel disease

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Editors,We read with great intriguing the research TriNetX network analysis by Yousaf Hadi et al 1 They described a decreased risk of COVID-19 infection in the IBD patients with incidence rate ratio of 0.79; another breakthrough was about no increased risk for new-onset IBD after COVID-19 infection. This research has produced valuable results.

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Letter: association between COVID‐19 and inflammatory bowel disease—Authors' reply

“…The author’s declaration of personal and funding interests are unchanged from those from the original article. 2 …”