scholarly journals P637 Incidence rate and clinical outcome of severe COVID-19 in Inflammatory Bowel Disease patients in a population-based setting

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S571-S572
Author(s):  
A Rezazadeh Ardabili ◽  
R H Creemers ◽  
D M A E Jonkers ◽  
M J L Romberg-Camps ◽  
M J Pierik ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Incidence Rate ◽  
Bowel Disease ◽  
Population Based ◽  
Icu Admission ◽  
Immunosuppressive Medication ◽  
Increased Risk ◽  
Associated Symptoms ◽  
Inflammatory Bowel ◽  
Time Of Admission

Abstract Background The broad use of immunosuppressants and biologicals in Inflammatory Bowel Disease (IBD) patients increases the susceptibility to severe infections, and possibly COVID-19. Recently, in a Swedish population-based study it was suggested that IBD patients are at an increased risk of hospitalization for COVID-19, although course of COVID-19 did not differ from controls. Data on the outcome of COVID-19 in IBD patients from heavily affected regions remain, however, limited. South-Limburg has the second highest COVID-19 mortality rate in the Netherlands. We aimed to determine the incidence rate and outcome of severe COVID-19 in IBD patients in a population-based setting in South-Limburg. Methods We identified all IBD patients who presented at the emergency department (ED) of the only two hospitals covering the whole South-Limburg region with COVID-19 associated symptoms between February 27 and November 1, 2020. Confirmed COVID-19 diagnosis was defined by a combination of COVID-19 associated symptoms and either a positive SARS-CoV-2 PCR or a CT-CORADS score ≥4. As primary outcome, the incidence rate of severe COVID-19 (i.e. confirmed COVID-19 diagnosis requiring hospitalization, and/or resulting in ICU admission or death) was determined. Baseline characteristics and data on COVID-19 course were collected. At present, the total IBD population in South-Limburg is set at 4980 patients. Results During a follow-up of 3384 person-years, a total of 61 IBD patients (1.22%) presented with COVID-19 associated symptoms at one of the two hospital’s ED. Of these, 18 IBD patients (0.36%; 11 UC, 7 CD) fulfilled the criteria for severe COVID-19, corresponding to an incidence rate of 5.3 per 1000 person-years. Furthermore, 12/18 patients were using immunosuppressive medication for their IBD. Mean age at time of admission was 64.5 years (SD: 10.8) and 55.6% were male. All hospitalized patients had at least one comorbidity (with ≥ 1 comorbidity in 13/18 patients (72.2%)), cardiovascular disease being most prevalent (12/18). Mean BMI at time of admission was 27.3 (SD: 4.2). Thirteen patients (72.2%) required oxygen support and three patients (16.7%) ICU admission (of which two needed mechanical ventilation), translating to an incidence rate of 0.9 per 1000 patient-years for ICU admission. Median length of hospitalization was 11 days (IQR: 5.3–18.3). No IBD patients died due to severe COVID-19. Conclusion The incidence rate of severe COVID-19 among IBD patients in a population-based setting in a heavily affected region was 5.3 per 1000 person-years. Despite frequent use of immunosuppressive medication and high region-specific mortality rates, clinical outcomes of severe COVID-19 were comparable to the general population and in line with recent literature.

scholarly journals Severe COVID-19 in inflammatory bowel disease patients in a population-based setting

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258271
Author(s):  
Rob H. Creemers ◽  
Ashkan Rezazadeh Ardabili ◽  
Daisy M. Jonkers ◽  
Mathie P. G. Leers ◽  
Mariëlle J. Romberg-Camps ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
General Population ◽  
Incidence Rate ◽  
Bowel Disease ◽  
Clinical Course ◽  
Population Based ◽  
Incidence Rates ◽  
Systemic Medication ◽  
Increased Risk ◽  
Inflammatory Bowel

Objective Data on the course of severe COVID-19 in inflammatory bowel disease (IBD) patients remains limited. We aimed to determine the incidence rate and clinical course of severe COVID-19 in the heavily affected South-Limburg region in the Netherlands. Methods All COVID-19 patients admitted to the only two hospitals covering the whole South-Limburg region between February 27, 2020 and January 4, 2021 were included. Incidence rates for hospitalization due to COVID-19 were determined for the IBD (n = 4980) and general population (n = 597,184) in South-Limburg. Results During a follow-up of 4254 and 510,120 person-years, 20 IBD patients (0.40%; 11 ulcerative colitis (UC), 9 Crohn’s disease (CD)) and 1425 (0.24%) patients from the general population were hospitalized due to proven COVID-19 corresponding to an incidence rate of 4.7 (95% Confidence interval (CI) 3.0–7.1) and 2.8 (95% CI 2.6–2.9) per 1000 patient years, respectively (Incidence rate ratio: 1.68, 95% CI 1.08–2.62, p = 0.019). Median age (IBD: 63.0 (IQR 58.0–75.8) years vs. general population: 72.0 (IQR 62.0–80.0) years, p = 0.10) and mean BMI (IBD: 24.4 (SD 3.3) kg/m2 vs. general population 24.1 (SD 4.9) kg/m2, p = 0.79) at admission were comparable in both populations. As for course of severe COVID-19, similar rates of ICU admission (IBD: 12.5% vs. general population: 15.7%, p = 1.00), mechanical ventilation (6.3% vs. 11.2%, p = 1.00) and death were observed (6.3% vs. 21.8%, p = 0.22). Conclusion We found a statistically significant higher rate of hospitalization due to COVID-19 in IBD patients in a population-based setting in a heavily impacted Dutch region. This finding reflects previous research that showed IBD patients using systemic medication were at an increased risk of serious infection. However, although at an increased risk of hospitalization, clinical course of severe COVID-19 was comparable to hospitalized patients without IBD.

Mo1250 Increased Risk of Intensive Care Unit (ICU) Admission in Inflammatory Bowel Disease (IBD): A Population-Based Study

2013 ◽  
Vol 144 (5) ◽  
pp. S-618
Author(s):  
Charles N. Bernstein ◽  
Allan Garland ◽  
Christine Peschken ◽  
Carol Hitchon ◽  
Randy Fransoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Inflammatory Bowel Disease ◽  
Intensive Care ◽  
Bowel Disease ◽  
Population Based ◽  
Population Based Study ◽  
Icu Admission ◽  
Increased Risk ◽  
Inflammatory Bowel

scholarly journals P777 Clostridioides difficile infection in children with inflammatory bowel disease: A Canadian population-based study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S616-S616
Author(s):  
W El-Matary ◽  
A Chandrakumar ◽  
H Zohni
Keyword(s):  
Inflammatory Bowel Disease ◽  
Incidence Rate ◽  
Bowel Disease ◽  
Cox Regression ◽  
Population Based ◽  
Categorical Variables ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel

Abstract Background Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhoea and gastroenteritis associated mortality, especially in children with inflammatory bowel disease (IBD). The aim of this work was to investigate the incidence and risk factors associated with Clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba, Canada. Methods Our longitudinal population-based cohort comprised of all children and young adults <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients. Results Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p = 0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR) = 4.30; 95% CI: 1.44–12.87) and anti-tumour necrosis factor (TNF) biologics (HR = 3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our paediatric IBD population was 25%. Conclusion Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy.

scholarly journals Impact of medical therapies for inflammatory bowel disease on the severity of COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 8 (1) ◽  
pp. e000774
Author(s):  
Fatema Alrashed ◽  
Robert Battat ◽  
Israa Abdullah ◽  
Aline Charabaty ◽  
Mohammad Shehab
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Severe Disease ◽  
Aminosalicylic Acid ◽  
Icu Admission ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Medical Therapies

BackgroundDuring COVID-19 pandemic, the safety of medical therapies for inflammatory bowel disease (IBD) in relation to COVID-19 has emerged as an area of concern. This study aimed to evaluate the association between IBD therapies and severe COVID-19 outcomes.MethodWe performed a systematic review and meta-analysis of all published studies from December 2019 to August 2021 to identify studies that reported severe COVID-19 outcomes in patients on current IBD therapies including 5-aminosalicylic acid (5-ASA), immunomodulators, corticosteroids, biologics, combination therapy, or tofacitinib.ResultsTwenty-two studies were identified. Corticosteroids (risk ratio (RR) 1.91 (95% CI 1.25 to 2.91, p=0.003)) and 5-ASA (RR 1.50 (95% CI 1.17 to 1.93, p=0.001)) were associated with increased risk of severe COVID-19 outcomes in patients with IBD patients. However, possible confounders for 5-ASA use were not controlled for. Sub-analysis showed that corticosteroids increased the risk of intensive care unit (ICU) admission but not mortality. Immunomodulators alone (RR 1.18 (95% CI 0.87 to 1.59, p=0.28)) or in combination with anti-TNFs ((RR 0.96 (95% CI 0.80 to 1.15, p=0.63)), tofacitinib (RR 0.81 (95% CI 0.49 to 1.33, p=0.40)) and vedolizumab ((RR 1.02 (95% CI 0.79 to 1.31, p=0.89)) were not associated with severe disease. Anti-TNFs (RR 0.47 (95% CI 0.40 to 0.54, p<0.00001)) and ustekinumab (RR 0.55 (95% CI 0.43 to 0.72, p<0.00001)) were associated with decreased risk of severe COVID-19.ConclusionIn patients with IBD, the risk of severe COVID-19 is higher among patients receiving corticosteroids. Corticosteroid use was associated with ICU admission but not mortality. The risk is also higher among patients receiving 5-ASAs. However, patient-level data were lacking and insufficient data existed for meta-regression analyses to adjust for confounding. Vedolizumab, tofacitinib, and immunomodulators alone or in combination with anti-TNF were not associated with severe disease. Anti-TNFs, and ustekinumab were associated with favourable outcomes.

scholarly journals Laryngeal Carcinoma in Patients With Inflammatory Bowel Disease: Clinical Outcomes and Risk Factors

2019 ◽  
Vol 26 (7) ◽  
pp. 1060-1067
Author(s):  
Steffi E M van de Ven ◽  
Lauranne A A P Derikx ◽  
Iris D Nagtegaal ◽  
Carla M van Herpen ◽  
Robert P Takes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Risk Factor ◽  
Bowel Disease ◽  
Case Control Studies ◽  
Transplant Patients ◽  
Immunosuppressive Medication ◽  
Survival Difference ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) patients are at increased risk for developing extra-intestinal malignancies, mainly due to immunosuppressive medication. The risk of developing head and neck cancer in immunosuppressed transplant patients is increased. The relation between IBD patients and laryngeal cancer (LC) remains unclear. We aimed (1) to identify risk factors in IBD patients for LC development and (2) to compare clinical characteristics, outcome, and survival of LC in IBD patients with the general population. Methods All IBD patients with LC (1993–2011) were retrospectively identified using the Dutch Pathology Database. We performed 2 case–control studies: (1) to identify risk factors, we compared patients with IBD and LC (cases) with the general IBD population; (2) to analyze LC survival, we compared cases with controls from the general LC population. Results We included 55 cases, 1800 IBD controls, and 2018 LC controls. Cases were more frequently male compared with IBD controls (P &lt; 0.001). For ulcerative colitis (UC), cases were older at IBD diagnosis (P &lt; 0.001). Crohn’s disease (CD) cases were more frequently tobacco users (P &lt; 0.001) and more often had stricturing (P = 0.006) and penetrating (P = 0.008) disease. We found no survival difference. Immunosuppressive medication had no impact on survival. Conclusions Male sex was a risk factor for LC in IBD patients. Older age at IBD diagnosis was a risk factor for UC to develop LC. Tobacco use and stricturing and penetrating disease were risk factors for LC development in CD patients. Inflammatory bowel disease was not associated with impaired survival of LC. Immunosuppressive medication had no influence on survival.

Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study

Gut ◽  
2019 ◽  
Vol 68 (9) ◽  
pp. 1597-1605 ◽  
Author(s):  
Simone N Vigod ◽  
Paul Kurdyak ◽  
Hilary K Brown ◽  
Geoffrey C Nguyen ◽  
Laura E Targownik ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Mental Illness ◽  
Cohort Study ◽  
Bowel Disease ◽  
Post Partum ◽  
Population Based ◽  
Incidence Rates ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
New Onset

ObjectivePatients with inflammatory bowel disease (IBD) have an elevated risk of mental illness. We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and post partum.DesignThis cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.ResultsAbout 22.7% of women with IBD had new-onset mental illness versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care and infant mortality.ConclusionWomen with IBD were at an increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.

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