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. 2022 May 10;16(4):591-600.
doi: 10.1093/ecco-jcc/jjab172.

Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients

Amanda Ricciuto  1   2   3 , Christopher A Lamb  4   5 , Eric I Benchimol  1   3   6   7 , Gareth J Walker  8 , Nicholas A Kennedy  9   10 , M Ellen Kuenzig  2 , Gilaad G Kaplan  11 , Michael D Kappelman  12 , Ryan C Ungaro  13 , Jean-Frederic Colombel  13 , Erica J Brenner  12 , Manasi Agrawal  13 , Walter Reinisch  14 , Anne M Griffiths  1   3   6 , Shaji Sebastian  15   16
Affiliations

Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients

Amanda Ricciuto et al. J Crohns Colitis. .

Abstract

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.

Keywords: COVID-19; disease activity; inflammatory bowel disease.

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Figures

Figure 1.
Figure 1.
Proportion of patients experiencing adverse COVID-19 outcomes by PGA category [p < 0.001 for both outcomes].
Figure 2.
Figure 2.
Joinpoint regression. Proportion of patients experiencing ICU/ventilation/death [A] and hospitalization [B] by decade.
See this image and copyright information in PMC

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