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Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study.
Sebastian, Shaji; Walker, Gareth J; Kennedy, Nicholas A; Conley, Thomas E; Patel, Kamal V; Subramanian, Sreedhar; Kent, Alexandra J; Segal, Jonathan P; Brookes, Matthew J; Bhala, Neeraj; Gonzalez, Haidee A; Hicks, Lucy C; Mehta, Shameer J; Lamb, Christopher A.
  • Sebastian S; Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK; Faculty of Health Sciences, University of Hull, Hull, UK.
  • Walker GJ; Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
  • Kennedy NA; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Exeter IBD Research Group, University of Exeter, Exeter, UK.
  • Conley TE; Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
  • Patel KV; Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Subramanian S; Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK; Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
  • Kent AJ; Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK.
  • Segal JP; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
  • Brookes MJ; Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK; Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, UK.
  • Bhala N; Department of Gastroenterology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
  • Gonzalez HA; Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK; Faculty of Health Sciences, University of Hull, Hull, UK.
  • Hicks LC; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
  • Mehta SJ; Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
  • Lamb CA; Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. Electronic address: christopher.lamb@newcastle.ac.uk.
Lancet Gastroenterol Hepatol ; 6(4): 271-281, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062703
Semantic information from SemMedBD (by NLM)
1. Evaluation procedure TREATS Acute ulcerative colitis
Subject
Evaluation procedure
Predicate
TREATS
Object
Acute ulcerative colitis
2. Evaluation procedure TREATS Patients
Subject
Evaluation procedure
Predicate
TREATS
Object
Patients
3. Acute ulcerative colitis COEXISTS_WITH COVID-19
Subject
Acute ulcerative colitis
Predicate
COEXISTS_WITH
Object
COVID-19
4. Acute ulcerative colitis PROCESS_OF Patients
Subject
Acute ulcerative colitis
Predicate
PROCESS_OF
Object
Patients
5. Acute care hospital LOCATION_OF Case-Control Studies
Subject
Acute care hospital
Predicate
LOCATION_OF
Object
Case-Control Studies
6. Acute ulcerative colitis PROCESS_OF Adult
Subject
Acute ulcerative colitis
Predicate
PROCESS_OF
Object
Adult
7. COVID-19 PROCESS_OF Cohort
Subject
COVID-19
Predicate
PROCESS_OF
Object
Cohort
8. cyclosporine TREATS Cohort
Subject
cyclosporine
Predicate
TREATS
Object
Cohort
9. First line treatment TREATS Cohort
Subject
First line treatment
Predicate
TREATS
Object
Cohort
10. tofacitinib TREATS Cohort
Subject
tofacitinib
Predicate
TREATS
Object
Cohort
11. cyclosporine TREATS Historical Cohort
Subject
cyclosporine
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TREATS
Object
Historical Cohort
12. First line treatment TREATS Historical Cohort
Subject
First line treatment
Predicate
TREATS
Object
Historical Cohort
13. tofacitinib TREATS Historical Cohort
Subject
tofacitinib
Predicate
TREATS
Object
Historical Cohort
14. thiopurine ADMINISTERED_TO Patients
Subject
thiopurine
Predicate
ADMINISTERED_TO
Object
Patients
15. History of previous events PROCESS_OF Control Groups
Subject
History of previous events
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PROCESS_OF
Object
Control Groups
16. Adrenal Cortex Hormones ASSOCIATED_WITH COVID-19
Subject
Adrenal Cortex Hormones
Predicate
ASSOCIATED_WITH
Object
COVID-19
17. Biological Factors ASSOCIATED_WITH COVID-19
Subject
Biological Factors
Predicate
ASSOCIATED_WITH
Object
COVID-19
18. Evaluation procedure TREATS Acute ulcerative colitis
Subject
Evaluation procedure
Predicate
TREATS
Object
Acute ulcerative colitis
19. Evaluation procedure TREATS Patients
Subject
Evaluation procedure
Predicate
TREATS
Object
Patients
20. Acute ulcerative colitis COEXISTS_WITH COVID-19
Subject
Acute ulcerative colitis
Predicate
COEXISTS_WITH
Object
COVID-19
21. Acute ulcerative colitis PROCESS_OF Patients
Subject
Acute ulcerative colitis
Predicate
PROCESS_OF
Object
Patients
22. Acute care hospital LOCATION_OF Case-Control Studies
Subject
Acute care hospital
Predicate
LOCATION_OF
Object
Case-Control Studies
23. Acute ulcerative colitis PROCESS_OF Adult
Subject
Acute ulcerative colitis
Predicate
PROCESS_OF
Object
Adult
24. COVID-19 PROCESS_OF Cohort
Subject
COVID-19
Predicate
PROCESS_OF
Object
Cohort
25. cyclosporine TREATS Cohort
Subject
cyclosporine
Predicate
TREATS
Object
Cohort
26. First line treatment TREATS Cohort
Subject
First line treatment
Predicate
TREATS
Object
Cohort
27. tofacitinib TREATS Cohort
Subject
tofacitinib
Predicate
TREATS
Object
Cohort
28. cyclosporine TREATS Historical Cohort
Subject
cyclosporine
Predicate
TREATS
Object
Historical Cohort
29. First line treatment TREATS Historical Cohort
Subject
First line treatment
Predicate
TREATS
Object
Historical Cohort
30. tofacitinib TREATS Historical Cohort
Subject
tofacitinib
Predicate
TREATS
Object
Historical Cohort
31. thiopurine ADMINISTERED_TO Patients
Subject
thiopurine
Predicate
ADMINISTERED_TO
Object
Patients
32. History of previous events PROCESS_OF Control Groups
Subject
History of previous events
Predicate
PROCESS_OF
Object
Control Groups
33. Adrenal Cortex Hormones ASSOCIATED_WITH COVID-19
Subject
Adrenal Cortex Hormones
Predicate
ASSOCIATED_WITH
Object
COVID-19
34. Biological Factors ASSOCIATED_WITH COVID-19
Subject
Biological Factors
Predicate
ASSOCIATED_WITH
Object
COVID-19
ABSTRACT

BACKGROUND:

There is a paucity of evidence to support safe and effective management of patients with acute severe ulcerative colitis during the COVID-19 pandemic. We sought to identify alterations to established conventional evidence-based management of acute severe ulcerative colitis during the early COVID-19 pandemic, the effect on outcomes, and any associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes.

METHODS:

The PROTECT-ASUC study was a multicentre, observational, case-control study in 60 acute secondary care hospitals throughout the UK. We included adults (≥18 years) with either ulcerative colitis or inflammatory bowel disease unclassified, who presented with acute severe ulcerative colitis and fulfilled the Truelove and Witts criteria. Cases and controls were identified as either admitted or managed in emergency ambulatory care settings between March 1, 2020, and June 30, 2020 (COVID-19 pandemic period cohort), or between Jan 1, 2019, and June 30, 2019 (historical control cohort), respectively. The primary outcome was the proportion of patients with acute severe ulcerative colitis receiving rescue therapy (including primary induction) or colectomy. The study is registered with ClinicalTrials.gov, NCT04411784.

FINDINGS:

We included 782 patients (398 in the pandemic period cohort and 384 in the historical control cohort) who met the Truelove and Witts criteria for acute severe ulcerative colitis. The proportion of patients receiving rescue therapy (including primary induction) or surgery was higher during the pandemic period than in the historical period (217 [55%] of 393 patients vs 159 [42%] of 380 patients; p=0·00024) and the time to rescue therapy was shorter in the pandemic cohort than in the historical cohort (p=0·0026). This difference was driven by a greater use of rescue and primary induction therapies with biologicals, ciclosporin, or tofacitinib in the COVID-19 pandemic period cohort than in the historical control period cohort (177 [46%] of 387 patients in the COVID-19 cohort vs 134 [36%] of 373 patients in the historical cohort; p=0·0064). During the pandemic, more patients received ambulatory (outpatient) intravenous steroids (51 [13%] of 385 patients vs 19 [5%] of 360 patients; p=0·00023). Fewer patients received thiopurines (29 [7%] of 398 patients vs 46 [12%] of 384; p=0·029) and 5-aminosalicylic acids (67 [17%] of 398 patients vs 98 [26%] of 384; p=0·0037) during the pandemic than in the historical control period. Colectomy rates were similar between the pandemic and historical control groups (64 [16%] of 389 vs 50 [13%] of 375; p=0·26); however, laparoscopic surgery was less frequently performed during the pandemic period (34 [53%] of 64] vs 38 [76%] of 50; p=0·018). Five (2%) of 253 patients tested positive for SARS-CoV-2 during hospital treatment. Two (2%) of 103 patients re-tested for SARS-CoV-2 during the 3-month follow-up were positive 5 days and 12 days, respectively, after discharge from index admission. Both recovered without serious outcomes.

INTERPRETATION:

The COVID-19 pandemic altered practice patterns of gastroenterologists and colorectal surgeons in the management of acute severe ulcerative colitis but was associated with similar outcomes to a historical cohort. Despite continued use of high-dose corticosteroids and biologicals, the incidence of COVID-19 within 3 months was low and not associated with adverse COVID-19 outcomes.

FUNDING:

None.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Colitis, Ulcerative / Colonoscopy / Colectomy / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Lancet Gastroenterol Hepatol Year: 2021 Document Type: Article Affiliation country: S2468-1253(21)00016-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Colitis, Ulcerative / Colonoscopy / Colectomy / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Lancet Gastroenterol Hepatol Year: 2021 Document Type: Article Affiliation country: S2468-1253(21)00016-9