Inflammatory Bowel Disease Is Associated With Significantly Worsened Clinical Outcomes Of Covid-19 Infection In A Retrospective Analysis Of 78,756 Patients Across 143 Hospitals

ABSTRACT

Coronavirus Disease 2019 (Covid-19) Has Been Diagnosed In Over 50 Million Individuals And Resulted In Greater Than 1 Million Deaths Since Its Discovery In December 2019. Currently, It Is Understood That Cardiovascular Disease, Diabetes, Hypertension, Chronic Lung Disease, Malignancy, Chronic Renal Disease, Obesity, And Smoking Confer Worse Outcomes In Those Afflicted With Covid-19. The Role Of Underlying Gastrointestinal Comorbidities On Covid-19 Prognosis Has Not Been Well Studied. Patients With Inflammatory Bowel Disease (Ibd) Have A Slightly Higher Overall Mortality Than The General Population. While The Pathogenesis Of Ibd Is Not Completely Understood, It Is Thought To Be The Consequence Of Dysregulated Immune Response. A Pair Of Small International Studies Demonstrated That Patients With Ibd Are At Increased Risk Of Covid-19 Infection, Especially When They Have Active Disease And Are Taking Immunosuppressive Therapy. However, The Characteristics And Outcomes Of Covid-19 In Patients With Ibd Remain Unclear. We Conducted A Large-Scale, Multicenter, Retrospective Study To Examine The Outcomes In Ibd Patients Hospitalized For Covid-19. Using Hca Healthcare’S Physician Services Clinical Data Warehouse, We Reviewed 78,756 Adult Patients Across 143 Hospitals Between January Through August 2020 With Covid-19, Yielding 78,572 Covid-19 Patients Without Ibd And 184 With Ibd. Unpaired T-Tests Of Covid-19 Patients With Ibd Compared To Those Without Ibd Showed That Patients With Both Covid-19 And Ibd Experienced Significantly Higher Mortality (8.15% Vs 6.10%, P=0.004), Significantly Higher Rates Of Icu Admission (25.54% Vs 16.49%, P=0.001), Significantly Higher Rates Of Ventilation (13.04% Vs 7%, P=0.002), And Significantly Longer Lengths Of Stay (Los) (7.92 ± 9.84 Vs 4.57 ± 7.87 Days, P<0.001). The Outcomes Of Length Of Stay Remained Significant On Paired T-Test When The 184 Patients With Covid-19 And Ibd Were Age-Matched To Covid-19 Patients Without Ibd. However, There Was No Statistical Significance In Mortality, Icu Admission, And Need For Ventilation When Age-Matched. Ibd Was Independently Associated With Increased Icu Admission (Or 1.5, Ci 1.04 – 2.117, P=0.026) And Need For Ventilation (Or 1.8, Ci 1.124 – 2.775, P=0.010) On Multivariable Regression Analysis, And Los (Or 2.337, Se 0.531, P<0.001) In Linear Regression Analysis. Our Data Corroborates Previous Studies Suggesting Protective Effects Of Female Sex, And Deleterious Effects Of Increasing Age, Myocardial Infarction, Congestive Heart Failure, Cerebrovascular Disease, Chronic Pulmonary Disease, Diabetes, And Cancer. In Summary, Based On Our Study, Patients With Both Ibd And Covid-19 Experienced Significantly Increased Rates Icu Admission, Ventilation, And Lengths Of Stay Compared To Patients With Covid-19 Alone (Table Presented) (Table Presented) (Table Presented) (Table Presented)