ABSTRACT
Introduction: Diagnostic IBD practice has been affected by COVID-19, with>50% of new diagnoses not having endoscopy in a UK nationwide study.1 A case series of delayed presentation of surgical complications related to IBD has been reported in Italy.2 We report a case of delayed diagnosis of severe Crohn's disease due to the pandemic. Case Description/Methods: 57 year old woman was seen for chronic diarrhea of two months duration in January 2020. Her past medical history is noted for type 2 diabetes. Patient reported foursix liquid bowel movements daily associated with severe abdominal pain in the lower abdomen unaffected by eating. Infectious evaluation was negative. A CT Abdomen without contrast in January 2020 showed terminal ileitis with a hazy infiltration of the fat and thickened small bowel loops suggestive of enteritis. Her fecal calprotectin and CRP were both elevated at 846 ug/g and 4.2 mg/dl, respectively. Patient was planned and scheduled for colonoscopy with random biopsies and terminal ileum intubation and small bowel capsule endoscopy. The planned procedures were deferred due to the pandemic as endoscopy services were not available at our institution between March 2020-July 2020. Patient was lost to follow-up until December 2020;patient expressed fear of receiving care amidst the pandemic. Colonoscopy in March 2021 was unremarkable endoscopically and histologically with difficulty in intubating the terminal ileum due to anatomy. Small bowel capsule endoscopy in March 2021 showed several aphthous ulcers and significant enteritis with diffuse ulcerations in the small bowel (Figure 1A-C). The findings are highly suggestive of Crohn's disease. Patient underwent CT Enterography in May 2021 that showed mucosal edema with wall thickening of the terminal ileum (Figure 1D). Patient is planned for biologic therapy for suspected small bowel Crohn's disease. Discussion: Our case report describes a case of delayed diagnosis of Crohn's disease due to unavailability of endoscopy services and patient-related factor of fear of the pandemic. Future studies should evaluate for any diagnostic delay in IBD care in the United States.
ABSTRACT
Introduction: Digestive laboratory abnormalities related to COVID-19 have been previously described, but most reports came from single centers and findings have been conflicting. We conducted a multi-center study using data from three large urban VA centers (New York Harbor VA, New Orleans VA and Detroit VA) to examine the association between demographics and digestive laboratory values with mortality on index hospitalization among individuals diagnosed with COVID-19. Methods: We manually extracted data on individuals hospitalized for COVID-19 between December 2019 and June 2020 at the three facilities. For this analysis, data on demographics and seven digestive laboratory values (highest AST, ALT, alkaline phosphatase, total bilirubin, and INR during admission, as well as lowest hemoglobin and platelets) were analyzed in relation to index hospitalization mortality. We performed descriptive statistics and conducted a multivariable logistic regression model. Results: Out of a total of 390 individuals who were hospitalized with COVID-19, 168 (43%) died and 222 survived. The median age of patients who died was higher than those who survived (75 vs. 69 years). The vast majority (94%) of patients were male. Black patients accounted for a higher proportion of those who died than those who survived (61% vs. 55%), whereas the opposite was true for Whites (26% vs. 31%) and Hispanics (9% vs. 12%). In the multivariable model (Table), mortality was associated with older age (OR 1.07, 95% CI 1.03-1.10), higher BMI (OR 1.05, 95% CI 1.01-1.10), higher AST (OR 1.01, 95% CI 1.004-1.02), lower ALT (OR 0.99, 95% CI 0.98-0.996), higher alkaline phosphatase (OR 1.02, 95% CI 1.01-1.02), and lower hemoglobin (OR 0.83, 95% CI 0.72-0.97). Conclusion: In this multicenter VA study of patients hospitalized with COVID-19 during the first half of 2020, overall mortality was 43%. For mortality during index hospitalization, we observed a positive association with age, BMI, AST, and alkaline phosphatase, and an inverse association with ALT and hemoglobin. Every 1 unit increase in hemoglobin was associated with 17% decreased odds of death. These findings suggest that commonly used digestive laboratory tests have prognostic significance for COVID-related survival.