ABSTRACT
Introduction: Multiple meta-analyses have shown that over 15% patients with COVID-19 have at least one gastrointestinal complaint, most commonly diarrhea. The effects on the gastrointestinal system are thought to be mediated by the high expression of angiotensin-converting enzyme 2 (ACE2) and cellular serine proteases (TMPRSS2) in enterocytes, which cause altered intestinal permeability. The purpose of this study was to determine the incidence of diarrhea as it relates to COVID-19 infection and to determine if having concomitant diarrhea had a significant impact on disease course. Method(s): A retrospective chart review of 164,730 patients in a hospital system who were older than 18 years of age and had a positive SARS-CoV-2 test from March 2020 to February 2022 was completed. Diarrhea was determined using ICD code or patient's symptoms. Patients with confounding variables such as IBD, IBS, Celiac, Clostridium difficile, and pancreatic insufficiency were excluded. Demographic clinical characteristics and outcomes, including inpatient admission and mortality, were compared in patients with and without diarrhea. The Mann-Whitney test and Fisher's exact or Chi-square test was used for continuous and categorical variables respectively and multivariate logistic regression was used to evaluate for significant differences in disease outcome between the two groups. (Table) Results: Of the 164,730 patients included, 14,648 (8.89%) had diarrhea at the time of SARS-CoV-2. 6,748/33,464 (20.16%) of inpatient admissions were associated with diarrhea. On multivariate analysis, diarrhea was an independent risk factor for inpatient hospitalization (OR 2.39, CI 95% 2.28-2.51, P, 0.001) and inpatient mortality (OR 1.15, CI 96% 1.06-1.26, P= 0.001) after controlling for age, gender, race, comorbidities that could impact patient outcome, use of immunomodulators and outpatient antibiotics. Conclusion(s): These findings show that, even with controlling for comorbidities with COVID-19, diarrhea was an independent factor for predicting inpatient mortality and inpatient admission in general. Patients who had diarrhea and COVID-19 were sicker, having more comorbid conditions than those without diarrhea in our cohort. Attention should be given to not only respiratory complaints of COVID-19, but also gastrointestinal complaints, as they are an indicator of poor prognosis and mortality.
ABSTRACT
Backgrounds Inflammatory bowel disease (IBD) is associated with a 2-to 3-fold increased risk of venous thromboembolism (VTE) and the risk is even higher in hospitalized IBD patients. Elevated risk of VTE has also been noted in patients with Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). In this study, we aimed to assess the risk of VTE among hospitalized IBD patients who had exposure to SARS-CoV-2 compared to those with no exposure. Methods All hospitalized patients with IBD including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) across Banner Health in Arizona with and without COVID-19 between March 2020 to October 2021 were included in the study. Baseline clinical demographics, comorbidities, risk factors associated with VTE, and rate of VTE were compared between groups using Wilcoxon-rank sum test, chi-square and Fisher's Exact tests as appropriate. The impact of COVID-19 on VTE was quantified using regression analysis. Of note, UC and IBD-U patients were grouped together for analyses. Results The study cohort of 8,977 (4643 CD, 3960 UC, 374 IBD-U) IBD patients had a median age of 55 (interquartile range [IQR], 37-69) years. 7% (n= 631) of hospitalized IBD patients contracted COVID-19 and it was more frequent in Hispanics (17.6% vs 9.4%, p<0.001). Baseline characteristics were similar among IBD patients with and without COVID-19 except steroid use (24% vs 15%, p<0.001), obesity (19% vs 12%, p<0.001), chronic kidney disease (16% vs 10%, p<0.001), and heart failure (13 % vs 6%, p<0.001) which were more frequent in patients with COVID-19 (Table). VTE rate was higher among IBD patients with COVID-19 compared to those without [8.1% (n= 51) vs. 4.4% (n=367), P< 0.001]. This association was still significant after multivariate adjustment for age, sex, race, IBD type, tobacco use, obesity, and other comorbidities (OR 1.43. 95% CI 1.04-2.0, P =0.03). UC compared to CD, was associated with greater VTE risk (OR 1.38. 95% CI 1.10-1.7, P =0.002). Similar association was also noted with tobacco use, obesity, malignancy, chronic kidney disease, and heart failure. Despite higher rate of COVID-19 in Hispanics, there was no increased risk of VTE (OR 0.95, 95% CI 0.7-1.4, P =0.768) in this group (Figure). Conclusions COVID-19 is an independent risk factor for VTE in hospitalized patients with IBD. Our findings suggest not only the need for early detection of VTE but also aggressive pharmacological prophylaxis against VTE in this population. Further studies are needed to evaluate the benefit of post-discharge thromboprophylaxis in this cohort. (Table Presented) (Figure Presented)