Incidence and evolution of SARS-CoV2 infection in patients with inflammatory bowel disease in Southern Spain (Andalusia)

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.