ABSTRACT
Background: Data on coronavirus disease 2019 (COVID–19) and its clinical implications on inflammatory bowel disease (IBD) are rapidly evolving. We performed a systematic review and meta-analysis to investigate clinical characteristics, therapeutic options and outcomes in IBD patients with COVID-19. Methods: Wesearched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv and Google Scholar from inception through October 2020. We included cohort studies that involved IBD patients with confirmed COVID-19. Two investigators independently screened the studies for inclusion and extracted the data. Data were collected on the prevalence of COVID-19 among patients with IBD, patient characteristics, pre-infection treatments for IBD, co-morbidities, hospitalization,intensive care unit (ICU) admission, and death. Results: Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the infection rate was 1.01%. Of IBD patients with COVID-19, 51.3% had Crohn’s disease, 41.5% had ulcerative colitis, and 6.4% had indeterminate colitis. Mean ages for patients ranged from 18 to 85 years and 60.71% were females. Nine studies (n = 687) reported outcomes according to IBD therapy received. Oral and rectal mesalamine was used in 23.4% of patients with 44.1% requiring hospitalization, 8.7% ICU admission, and 6.8% deaths (Table). Immunomodulators (methotrexate, azathioprine, 6-mercaptopurine) were used in 12.4% of patients with 37.6% requiring hospitalization, 3.5% ICU admission, and 2.4% deaths. Anti-tumor necrosis factor (TNF) therapies were used in 37.2% patients with 12.9% requiring hospitalization, 1.2% ICU admission, and 0.8% deaths. Outcomes related to corticosteroid use could not be delineated with available data. Conclusions: The infection rate for COVID-19 in IBD patients was lower than that of general population. Use of mesalamine was significantly associated with worse hospitalization outcomes, while use of anti-TNFs was associated with favorable hospitalization outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.(Table Presented)
ABSTRACT
Background: During The Covid-19 Pandemic, The General Population Has Been Subject To Heightened Stress, Anxiety, Depression, And Fear Of The Virus. However, The Impact Of Covid-19 On These Psychometric Factors Have Not Been Formally Assessed In Patients With Inflammatory Bowel Disease (Ibd), Specifically Those On Biologic Therapies. The Aim Of This Study Was To Examine The Relationship Between Fear Of Covid-19 And Biologic Usage In Ibd Patients. Methods: Adult Ibd And Non-Ibd Patients Were Recruited From An Academic Clinic And Via Social Media Outlets. Patients Were Administered A Qualtrics Survey Assessing Demographics Disease Characteristics, And Perceptions Around Covid-19. The Validated Fear Of Covid-19 Scale (Fcv-19s), Perceived Stress Scale (Pss), And Hospital Anxiety And Depression Scale (Hads) Were Used To Assess Fear Of Covid-19, Stress, Anxiety And Depression, Respectively. Analyses Evaluated The Associations Between These Psychological Experiences, Ibd Diagnosis, And Medication Usage. Results: There Were 399 Participants (17% Crohn’S Disease;43% Ulcerative Colitis;4% Ibd-Unclassified;36% Non-Ibd). Ibd Participants Had Higher Levels Of Stress (P<.01), Anxiety (P<.01), Depression (P<.01), And Fear Of Covid-19 (P<.01) Compared With Non-Ibd Participants. When Asked About Perceived Likelihood Of Contracting Covid-19, Ibd Participants More Often Responded With A “High” Or “Extreme” Likelihood (26.3% Vs. 9.1%;P<.01). Among The Risk Perception Screening Domains, 77.9% And 45.9% Of Ibd Participants On Biologics Responded “Very” Or “Extremely” Affirmatively To Questions Related To Perceived Level Of Precaution Needed To Avoid Contracting Covid-19 And Perceived Severity Of Infection If Contracted, Respectively. Additionally, 41.5% Of Ibd Participants On Biologics Were More Likely To Report Feeling That Their Ibd Medications Made Them “Extremely” Or “Very” Vulnerable, Compared With Only 20.3% Of Ibd Participants Not On Biologic Therapy. Use Of Biologic Therapy Was Associated With Higher Levels Of Stress (P=.011), Anxiety (P<.01), And Fear Of Covid-19 (P<.01). Due To Concerns Of Covid-19, 5.6% Decided To Defer Starting Biologic Treatment, While 2.0% Decided To Discontinue Biologic Medication. Conclusion: This Study Is One Of The First To Evaluate The Mental Health Of Ibd Patients During The Covid-19 Pandemic And Uniquely Evaluates Psychological Variables As They Relate To Biologic Usage. Fear Of Covid-19, Anxiety, And Perceived Stress Were Strongly Correlated With Biologic Usage In Ibd Patients, Suggesting That Participants Using Biologic Therapy Felt More Susceptible To Infection. Furthermore, These Findings Have Implications On Patient Adherence To Immunosuppressive Medications During The Covid-19 Pandemic, Which Should Be Considered During Therapy-Related Discussions Between Physicians And Ibd Patients (Table Presented)
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has infected over 62 million people worldwide as of November 28, 2020. Emerging studies have revealed a high prevalence of gastrointestinal (GI) symptoms among patients with COVID-19, and coronavirus particles have been found in their stool. However, there are minimal data regarding the impact of COVID-19 severity on the GI system. In this study, we evaluated GI and hepatobiliary manifestations in a large number of hospitalized patients across the United States (US) with COVID-19 based on admission to the intensive care unit (ICU), a surrogate for COVID-19 severity. Methods: Seven US academic centers ed data from patients who had a positive COVID-19 test and were hospitalized. Demographics, presenting symptoms, clinical, and laboratory data were ed, as were hospitalization outcomes. Patients were stratified According to admission to the ICU (yes/no) during their hospital course. GI and hepatobiliary manifestations and outcomes were compared using the Chi-square test, and parametric laboratory values were compared using Student’s t test. Results: Of a total of 1,896 COVID-19 positive patients, 730 patients (38.5%) were admitted to the ICU (Table 1). ICU admissions were more likely to be male (64.2% vs. 52.1%;p<0.01). The most common presenting symptom was dyspnea in ICU patients (57.8%) versus cough in non-ICU patients (47.9%).The prevalence of patients reporting GI symptoms was similar between ICU and non-ICU patients (20.4% vs 21.1%;p=0.14). Compared with non-ICU patients, ICU patients had a higher prevalence of abnormal serum aspartate aminotransferase (AST) values (16.0% vs. 6.7%;p<0.01) and total bilirubin > 3 mg/dL (3.1% vs. 0.8%;p<0.01) (Table 2). There was not a significant difference in prevalence of abnormal alanine aminotransferase (ALT) values between the two groups (9.6% vs. 7.1%;p=0.13). The peak values of AST, ALT, and total bilirubin among all patients in the cohort were 3384 U/L, 1274 U/L, and 54 mg/dL, respectively. Conclusions: In a large US-based cohort of hospitalized patients with COVID-19, GI symptoms did not differ between ICU and non-ICU patients despite their high prevalence. ICU patients were more likely to have serum liver test abnormalities. In this context, further investigation is needed to clarify whether hepatobiliary dysfunction stems from direct injury from COVID-19 or an indirect effect of ICU-related multi-organ dysfunc-tion. Such insight would help guide future management to reduce the risk of and mitigate hepatic injury in these patients (Table Presented) (Table Presented)
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has infected over 14 million people in the United States (US) as of December 1, 2020. Recent data have shown that COVID-19 strains appear to demonstrate geographic variation, such as Asian strains predominating in the Western US and European strains predominating in the Eastern US. However, the clinical significance of this variation remains unclear. In this large, multi-center cohort study, we evaluated gastrointestinal (GI) manifestations of COVID-19 regionally and throughout the US. Methods: Patients hospitalized with a positive COVID-19 test were identified at seven US academic centers. As a surrogate for differing COVID-19 strains, patients were stratified into regions (West, Midwest, or Northeast) depending on hospital location. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were ed. Statistical comparisons were performed with Chi-square and ANOVA tests, as appropriate. Results: A total of 1896 patients were identified (Table 1). Most patients were male (56.8%), and the most prevalent race was Caucasian (40.5%). The mean age was 58.1 years (±19.1), and the mean body mass index (BMI) was 29.9 (±8.4). A third (29.2%) of patients had a known COVID-19 exposure. The mean presenting temperature was 37.3 °C, and dyspnea was the most common presenting symptom (48.2%). GI symptoms were present in 20.3% of the overall cohort (Table 2);diarrhea was most common (12.4%), followed by nausea and/or vomiting (10.3%) and abdominal pain (6.0%). Geographically, GI symptoms were significantly less common in the Western cohort (17.8%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. GI complications (GI hemorrhage and pancreatitis) were also significantly less common in the Western cohort (1.5%, 0.2%) than the Northeastern (6.9%, 1.5%) and Midwestern (3.3%, 1.7%) cohorts. The Midwestern cohort had a higher prevalence of moderately elevated serum aspartate aminotransferase (AST;23.5% vs 8.5% in Western and 10.5% in Northeastern cohorts;p<0.01). Compared to the Northeastern and Midwestern cohorts, the Western cohort had a higher prevalence of mildly elevated serum alanine aminotransferase (ALT;20.9% and 20.9% vs 28.5%;p=0.01) and total bilirubin (6.7% and 7.0% vs 11.4%;p=0.03). The presence of GI symptoms was not associated with increased mortality (p=0.15). Conclusions: Although GI manifestations were common among patients hospitalized with COVID-19, there is significant variability in prevalence across the US. GI symptoms and complications were less common in the West than the Northeast or Midwest. Our study highlights notable geographic variations in GI manifestations of COVID-19, prompting the need for further investigation into the mechanisms of these differences. Such insight could identify strategies that mitigate GI complications of COVID-19 infection.(Table presented) Demographic and Clinical Data of Patients with COVID-19 by Geographic Region. (Table presented) Gastrointestinal Manifestations of COVID-19 in Patients by Geographic Region.