ABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causativeagent of COVID-19 pandemic, is affecting the health care system globally. Patients withinflammatory bowel disease (IBD), such as those with Ulcerative Colitis (UC) and Crohn’sDisease (CD), may be prone to have more severe COVID-19 infection, as compared tohealthy individuals. As a result, widespread concern exists among gastroenterologists andIBD patients, especially those on immunosuppressive therapy, regarding risks of COVID-19 and it's complications. In this study we aim to consolidate the current evidence on therisk and clinical outcomes of COVID-19 in IBD patients by meta-analysis methods.METHODS: We searched multiple databases from inception through June 2020 to identifystudies that reported on outcomes of COVID-19 in patients with IBD. Outcomes from theincluded studies were pooled to estimate the risk of COVID-19 infection and its clinical outcomes.RESULTS: A total 1773 IBD patients with COVID-19 were analyzed from eight studies.Average age was 46.6 (7-86) years. 54% were males. While 53% patients had UC and 43%patients had active disease. 10.5% patients were on combination therapy, 20.7% on salicylicacid derivatives, 11.2% on steroids, 9% on immunomodulators and 54.7% on biologics.Most common presenting symptoms were fever, cough and dyspnea. Five studies provideddata that enabled the calculation of COVID-19 incidence in IBD patients. The pooledincidence of COVID-19 was 1.1% (95% CI 0.1-8.5;I2=98%). Variation to the pooled ratewas observed when sensitivity analysis was performed by removing one study at a time.The pooled values ranged from 0.5% to 1.6%. Four studies provided information on thecumulative COVID-19 incidence in the general population at the time the studies wereconducted. Incidence of COVID-19 in IBD patients was similar to the general population,and the pooled odds ratio (OR) was 1.3 (95% CI 0.5-3.7;I2=69%),p=0.6.The pooled rate of IBD patients admitted to hospital due to COVID-19 was 27.3% (95%CI 20.5-35.3;I2=60%), while rate of ICU admission was 5.7% (95% CI 4.7-6.9;I2=3%).The pooled rate of death in IBD patients due to COVID-19 was 5% (95% CI 2.5-9.5;I2=46%), whereas fatality among IBD patients admitted to ICU was 61.1% (95% CI 51.1-70.3;I2=0%). Meta-regression analysis based on IBD type, disease activity and immunosuppressanttherapy did not demonstrate significant effect on the pooled rates of clinical outcomes.CONCLUSION: Risk of COVID-19 in IBD patients is not increased when compared to thecumulative COVID-19 incidence in the general population. Rates of hospitalization, ICUadmission and death due to COVID-19 seem favorable compared to the general population.Meta-regression analysis seems to suggest that IBD patients need not change their immunosuppressanttherapy due to the ongoing COVID-19 pandemic.(Image Presented)(Image Presented)