ABSTRACT
Introduction: The respiratory infection caused by SARS-CoV2, known as COVID-19, has presented a fast worldwide expansion with significant sanitary repercussion as well as social and economic. Globally, patients with inflammatory bowel disease (IBD) have been considered as population at risk for viral infections. To date, the evidence has not proved an increased risk for COVID-19 in this group. Aims & Methods: Our aim was to describe the main characteristics of our IBD patients who suffered SARS-CoV2 infection and to analyze both the evolution of their IBD and the infection's evolution. An observational, longitudinal, ambispective and multicentric study was performed. Patients with IBD with positive SARS-CoV2 PCR were included. Demographic variables along with data regarding to the COVID-19 infection were collected. SPSS® software version 20.0 was used for the statistic analysis. Results: We included 97 patients, 51.5% men. Overall mean age 43 (16-73) years old. Active smokers 13.5%, hypertensive 15.5%, diabetics 7.2% and obese 6.2%. According to the IBD 39.2% suffered from ulcerative colitis (UC), 55.7% Crohn's disease (CD), 2.1% linfocitic colitis and 2.1% indeterminate colitis. Mean IBD duration was 10.3 (SD 8.3) years. Perianal disease was present in 16.5% and extraintestinal manifestations (EIMs) 26.8% (77% joint involvement). Upon the time of infection 28.4% had active IBD. Regarding treatment, 55.7% were on aminosalycilates (5ASA), 45.8% on immunosuppressants, 25% on steroids and 41.7% on biologics. The main symptoms of SARS-CoV2 infection were astenia (62%), cough (60%), fever (58%), headache (52%) and diarrhoea (45%). Hospital admission was required in 24.2% (61% suffering from severe respiratory disease) and ICU was required in 17.4% of them. There were no deaths. Compared to those who did not need hospital admission;the admitted patients were older (50 vs 40 years old, p=0.006), were more likely to be obese (20% vs 2.8%, p=0.017), to suffer from hypertension (39% vs 8.3%, p=0.0001), from heart failure (13% vs 0%, p=0.002), had more EIMs (43.5% vs 22.2%, p= 0.047), had a higher previous hospitalization within the last 3 months (43.3% vs 8.3%, p=0.002), were more on 5ASA (91.3% vs 45.8%, p=0.0001) and showed higher C-reactive protein levels (71 vs 13.7, p=0.017). Hospitalized patients were more likely to present diarrhoea (63.8% vs 36.2%, p=0.009), dyspnoea (65.2% vs 20.6%, p=0.0001), hypoxemia (39.1% vs 1.5%, p=0.0001), hyporexia (60.9% vs 19.1%, p=0.0001), abdominal pain (36.4% vs 14.5%, p=0.025) and fever (82.6% vs 50%, p=0.006). Related to need of ICU admission, EIMs (75% vs 25.3%, p=0.029) and previous admission within the last 3 months (50% vs 13.2%, p=0.042), were more frequent. Neither immunosuppressant treatment (45.8% vs 47.8%, p=0.87) nor biologic therapy (43.1% vs 34.8%, p=0.48) were related to the need for hospital admission. Conclusion: A quarter part of the patients with IBD and SARS-CoV2 infection needed hospitalisation. An older age, presence of comorbidities, hospital admission within the previous 3 months, treatment with 5ASA and EIMs were more frequent in those requiring admission. There was not identified any relation between active IBD or the use of immunosuppressants/ biologics and a worse evolution of the infection.
ABSTRACT
Introduction: Inflammatory bowel disease (IBD) patients undergoing treatment with drugs that act on the immune system present an increased risk of infections in general1. For this reason, we could consider that these patients may have an increased risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, however, it remains unclear2. We aimed to analyze the cumulative incidence, the severity of the SARS-COV2 infection and its influence on the natural history of IBD in patients under biological treatment, also evaluating the possible differences with another group without these treatments. Aims & Methods: Retrospective observational study about our IBD patients followed between March 2020 and January 2021 divided into two groups: patients on treatment with biological drugs (anti-TNF, vedolizumab, ustekinumab and tofacitinib) and patients without biological therapy as thiopurines or mesalamine (5-ASA). We evaluated: the cumulative incidence in 10 months for COVID-19 in the 2 cohorts;clinical variables considered risk factors for the infection (sex, age, hypertension, diabetes, dyslipidemia, cardiovascular disease, body mass index)3,4;the infection severity (visits to the emergency room, need for hospital admission, type of treatment received) and influence on the course of IBD (Harvey- Bradshaw index and Mayo partial in Crohn's disease and ulcerative colitis respectively, before and after COVID-19). Results: It collected 755 IBD patients treated in our centre. Of these, a total of 89 patients were infected by SARS-COV-2, 43 belonged to the biologics group and 46 were to 5-ASA and thiopurines group treatment. Only 3 patients out of 89 were being treated with corticosteroids. We verified the groups' comparability discarded the existence of statistical differences in age, sex distribution and the rest of the risk factor's. The cumulative incidence in 10 months was 10.85% in the biologics group and 12.81% in the group without biologics, with no incidence significant differences. In most cases, the infection was mild (94.4%) and the required treatment was symptomatic in 86.4% of the total, without significant differences between groups. Pneumonia was diagnosed in 5 patients, whose required hospital admission (3 belonged to the biological group and 2 to the other). Only 18 patients (20,2%) required one emergency room visit and the rest none. The maximum respiratory support required was FIO2 36%, no patient required admission to the intensive care unit and there were no deaths. Additionally, the course of IBD was not affected as a result of COVID-19, considering no significant differences were observed in clinical scores in each group before and after infection, even though 14 of the patients in the biological group discontinued these medications temporarily during infection (mean 2.87 weeks). None of the patients in the thiopurines and 5-ASA group discontinued the drug Conclusion: Our study suggests that IBD patients under biological treatment do not have an increased incidence of SARS-COV-2 infection and also do not have a higher risk of severe disease than IBD patients with other treatments (5-ASA or thiopurines).