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Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients
Amanda Ricciuto1,2,3, Christopher A Lamb4,5, Eric I Benchimol1,3,6,7
1SickKids IBD Centre, Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children.
Insights
Active inflammatory bowel disease [IBD] increases the risk of severe COVID-19, especially in younger patients. Maintaining IBD control and preventing infection are crucial for better outcomes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Age is a significant prognostic factor for COVID-19 outcomes.
- The impact of inflammatory bowel disease [IBD] activity on COVID-19 severity remains unclear.
- This study investigates the interplay between IBD activity and COVID-19 severity, considering age as a critical variable.
Purpose of the Study:
- To examine the relationship between inflammatory bowel disease [IBD] activity and COVID-19 severity.
- To determine if age modifies the association between IBD activity and adverse COVID-19 outcomes.
- To identify risk factors for severe COVID-19 in patients with IBD.
Main Methods:
- A cohort of 6078 IBD patients diagnosed with COVID-19 was analyzed from the SECURE-IBD registry (March 2020 - August 2021).
- Clinical IBD activity was assessed using physician global assessment [PGA].
- COVID-19 outcomes included ICU admission, ventilation, death, and hospitalization, with analyses stratified by age (≤50 vs >50 years).
Main Results:
- Active IBD correlated with increased rates of severe COVID-19 outcomes (ICU/ventilation/death and hospitalization).
- The association between severe IBD activity and adverse COVID-19 outcomes was more pronounced in patients aged 50 years and younger.
- Severe PGA was an independent risk factor for ICU/ventilation/death (aOR 3.27) and hospitalization (aOR 4.62) in patients ≤50 years, but not in older patients.
Conclusions:
- Clinically active inflammatory bowel disease [IBD] is a potential risk factor for severe COVID-19, particularly in younger individuals.
- Effective IBD disease control, including medication adherence, is vital.
- Implementing strategies to minimize COVID-19 infection risk in active IBD patients is essential for mitigating adverse outcomes.
Background And Aims:
Age is a major prognostic factor for COVID-19 outcomes. The effect of inflammatory bowel disease [IBD] activity on COVID-19 is unclear. We examined the relationship between IBD activity and COVID-19 severity according to age.
Methods:
We included IBD patients diagnosed with COVID-19, reported to SECURE-IBD between March 13, 2020 and August 3, 2021. Clinical IBD activity was measured by physician global assessment [PGA]. COVID-19-related outcomes were [1] intensive care unit [ICU] admission, ventilation or death, and [2] hospitalization. Using generalized estimating equations, we determined adjusted odds ratios [aOR, 95% confidence interval] for moderate and severe PGA vs clinical remission/mild PGA, controlling for demographics, medications and COVID-19 diagnosis period. We performed stratified analyses by age [≤50 vs >50 years].
Results:
Among 6078 patients, adverse COVID-19 outcomes were more common with active IBD: ICU/ventilation/death in 3.6% [175/4898] of remission/mild, 4.9% [45/920] of moderate and 8.8% [23/260] of severe [p < 0.001]; and hospitalization in 13% [649/4898] of remission/mild, 19% [178/920] of moderate and 38% [100/260] of severe [p < 0.001]. Stratified by decade, effect sizes were larger for younger patients. In patients ≤50 years, severe PGA was independently associated with ICU/ventilation/death (aOR 3.27 [1.15-9.30]) and hospitalization (aOR 4.62 [2.83-7.55]). In contrast, severe PGA was not independently associated with COVID-19 outcomes in those older than 50 years.
Conclusions:
Clinically active IBD may be a risk factor for severe COVID-19, particularly in younger patients. IBD disease control, including through medication compliance, and strategies to mitigate the risk of COVID-19 infection amongst patients with active IBD [e.g. distancing, immunization] are key to limit adverse COVID-19 outcomes.
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