Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

Abstract

ObjectivesCOVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear.DesignThis Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death).ResultsBetween 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death.ConclusionsActive IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.

Covid-19 and the management of patients with inflammatory bowel disease: a practical decalogue for the post-pandemic phase

“…18 As of 16 June 2020, 57% of IBD patients taking oral or parenteral steroids needed hospitalization, with 19% experiencing unfavorable outcomes defined as intensive care unit admission, ventilator use, or death. 19 These findings were further supported by the results of the IG-IBD study, which reported a significant association between use of steroids and COVID-19-related pneumonia ( p = 0.05) and a trend towards increased mortality ( p = 0.064). 13 However, we cannot rule out that some confounding factors may have influenced these data.…”

“…A retrospective study from the United States including a large cohort of IBD patients reported that the incidence rate of COVID-19 per 1000 IBD patients was of 0.61 in patients treated with anti-TNF-α and 1 in those not in treatment with anti-TNF-α ( p = 0.618). 16 Interestingly, a recent case report 17 and larger studies 18 , 19 hypothesized that anti-TNF-α antibodies could guarantee a milder course of COVID-19. In fact, in the SECURE-IBD database (>1500 patients enrolled), as of 16 June 2020, 16% of patients treated with anti-TNF-α agents required hospitalization, and only 2% experienced unfavorable outcomes, defined as intensive care unit admission, ventilator use, or death.…”

Addendum to S3-Guidelines Crohn’s disease and ulcerative colitis: Management of Patients with Inflammatory Bowel Disease in the COVID-19 Pandemic – open questions and answers

“…There is no doubt that, in patients with IBD, the risk of infection or a severe course of disease is influenced by drug therapies ("therapy as a risk factor"). [58]. In view of these findings, adequate control of the underlying disease and compensation of nutritional deficiencies are therefore paramount.…”

Inflammatory bowel disease amid the COVID-19 pandemic: impact, management strategies, and lessons learned

“…With regard to IBD-specific risk factors, it is speculated that patients on immunosuppressive agents, those with active IBD symptoms, malnutrition, and frequent visits to clinics or hospitals are at greater risk of acquiring SARS-CoV-2 infection [ 50 ]. In an Italian study of 79 IBD patients, the risk factors associated with COVID-19-related mortality included age >65 years (OR 19.6, 95%CI 2.95-130.6), Charlson comorbidity index >1 (OR 16.6, 95%CI 1.80-153.9), and active IBD (OR 8.5, 95%CI 1.26-56.56) [ 51 ]. Table 1 outlines the risk factors for COVID-19 infection and poor outcomes [ 2 - 4 , 7 , 13 , 51 ].…”