Abstract and Introduction
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 multi-institutional 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.
Coronavirus disease-2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2 has caused more than 4.1 million deaths worldwide at the time of writing. The clinical course of COVID-19 is highly variable, with presentations ranging from asymptomatic infection to multi-organ failure, acute respiratory syndrome and death.[2,3]
The SARS-CoV-2 virus gains entry into hosts by binding angiotensin-converting enzyme 2 receptor, that is also expressed in the intestinal epithelium, primarily in the terminal ileum and colon, more so when inflamed. Thus, comorbid inflammatory bowel disease (IBD), particularly in the setting of immunosuppression, has been postulated to alter the risk and/or disease course of COVID-19. Whether concomitant IBD increases the risk of COVID-19 or poorer outcomes for COVID-19 disease has not been sufficiently explored. Previous studies have shown that the risk of COVID-19 disease in patients with IBD is likely similar or less than the non-IBD population.[5–7] Furthermore, some studies have raised concerns for poorer outcomes of COVID-19 in IBD subgroups. While the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) registry explored outcomes of COVID-19 disease in IBD patients, there were some limitations including lack of a control population or adequate matching for confounders to provide accurate estimations of risk as well as a selection bias.[8,9] In addition, the risk of an IBD flare after COVID-19 illness and any potential impact of COVID-19 disease on the risk of de novo (incident) IBD is unexplored.
We studied the relationship between COVID-19 and IBD using a large multi-institutional research network. Outcomes of COVID-19 disease in IBD were studied and compared to matched populations. Incidence of COVID-19 in patients with IBD was calculated and compared to the non-IBD population, and the relationship between COVID-19 and incident cases of IBD was explored.
Aliment Pharmacol Ther. 2022;55(2):191-200. © 2022 Blackwell Publishing