Symptoms, outcomes worse in IBD patients infected with SARS-CoV-2 early in pandemic
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Key takeaways:
- Patients infected with SARS-CoV-2 during the first wave were older and more likely to have ulcerative colitis.
- These patients were more symptomatic and had higher rates of hospital admission, ventilatory support and death.
Patients with inflammatory bowel disease infected with SARS-CoV-2 during the first and second waves of the pandemic experienced different symptoms and outcomes, consistent with those of the general population in Italy, researchers reported.
“In patients with IBD, the risk of SARS-CoV-2 infection is not higher than among the general population,” Cristina Bezzio, MD, PhD, medical director in the gastroenterology unit at Rho Hospital, and colleagues wrote in BMC Gastroenterology. “Furthermore, the risk of a severe COVID-19 course, requiring ventilation or leading to death, is similar in IBD patients to that of the general population. ... Despite these studies on COVID-19 in IBD patients, no study has yet compared the impact of the infection between first and second pandemic waves.”
In an observational, longitudinal study, Bezzio and colleagues evaluated characteristics and outcomes of 937 Italian patients with IBD infected with SARS-CoV-2 during the first (March 1, 2020-May 31, 2020) and second (Sept. 15, 2020-Dec. 15, 2020) waves of the pandemic.
Patients infected during the first wave (n = 219) were older (mean age, 46.3 years vs. 44.1 years), more likely to have ulcerative colitis (58% vs. 44.4%) and other comorbidities (48.9% vs. 38.9%) and more frequently resided in northern Italy (73.1% vs. 46%) compared with patients infected during the second wave (n = 718). There were no significant differences in sex (men, 54.3% vs. 53.3%), frequency of active disease (44.3% vs. 39%) or use of IBD therapies between groups.
Fewer patients were asymptomatic in the first wave (9.1% vs. 15.6%), with more frequent respiratory (68.9% vs. 53.9%) and systemic (78.5% vs. 66.7%) symptoms reported in this group. Gastrointestinal symptoms were slightly more frequent in the first wave as well.
Similarly, patients infected in the first wave had significantly higher rates of negative outcomes, including pneumonia (27.8% vs. 11.7%), hospital admission (27.4% vs. 9.7%), ventilatory support (11.9% vs. 5.4%) and death (5.5% vs. 1.8%).
“Demographic, clinical and geographical features of IBD patients with SARS-CoV-2 infection were different between first and second waves,” Bezzio and colleagues concluded. “Moreover, symptoms and outcomes of SARS-CoV-2 infection were different between the two pandemic waves. These findings are consistent with those observed in the general population and are likely due to the different epidemiological situations and diagnostic possibilities between the two periods.”
They continued: “Our findings reinforce the message that IBD is not a risk factor for worse outcomes of SARS-CoV-2 infection.”
Perspective
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Sara El Ouali, MD
A key finding of this study was the significantly higher rate of negative outcomes during the first wave, including hospitalization, pneumonia, ICU admission and death. However, a similar trend was seen among the general population in Italy, and there was no increased risk for poor outcomes in patients with IBD compared with the general population. This is reassuring and in line with previously published data showing no increased risks for COVID-19 complications in patients with IBD.
Several factors may have contributed to better outcomes during the second wave, including public health measures such as social distancing and the use of face masks, as well as increased access to testing. Testing in the early phases of the pandemic in Italy was performed in the sickest patients, leading to a seemingly higher rate of complications among SARS-CoV-2 positive patients. This also can explain the significantly increased rate of symptomatic patients in the first wave compared with the second wave.
Lastly, this study did not show an overall increased risk for SARS-CoV-2 infection among patients with IBD compared with the general population, which also is in line with previously published data and further contributes to our understanding of the impact of COVID-19 in IBD.
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