LAS VEGAS — A history of inflammatory bowel disease (IBD) was associated with an increased risk of sepsis, shock, and acute kidney injury (AKI) in patients hospitalized for COVID-19, according to a nationwide analysis.
After adjusting for demographic and hospital factors, IBD was associated with increased risks of sepsis (adjusted OR 1.15, P=0.01), shock (aOR 1.26, P=0.007), and AKI (aHR 1.25, P<0.001), reported Rakahn Haddadin, MD, of Sunrise Health System in Las Vegas, at the Crohn’s & Colitis Congress.
Of note, the researchers did not find any difference in incidence of mechanical ventilation or in-hospital mortality between patients with and without IBD.
“IBD patients who develop COVID-19 infection should be evaluated diligently as their disease state may predispose them to shock and organ injury,” Haddadin and colleagues noted in their poster. “Further studies are needed to elucidate why these patients do not have an increased rate of ventilator-dependent respiratory failure or death.”
David Schwartz, MD, director of the Inflammatory Bowel Disease Center at Vanderbilt University Medical Center in Nashville, Tennessee, suggested that it’s difficult to know the clinical implications of the research without more information about the patient population.
“This is interesting, but because we do not know the severity of their IBD nor concomitant meds, it is hard to generalize these findings to current practice,” said Schwartz, who was not involved in the study.
It’s also not clear how these findings might be generalized with regards to patients’ vaccination status, since the study population, in 2020, would not have had access to vaccination or immunity from a prior infection.
“We will continue to encourage vaccination as a way to prevent these types of outcomes in our patients,” Schwartz added.
Haddadin said he expects that more recent findings from cohorts of IBD patients hospitalized with COVID may differ slightly from the findings seen in this 2020 cohort.
“New treatment options for COVID have come out, and, as physicians, we know more about the disease and how it affects the body,” Haddadin told MedPage Today. “These variables could have a slight impact on the results we have gained.”
He also noted steps that clinicians and patients can take to lessen the likelihood of experiencing more severe outcome from COVID.
“We believe patients with IBD should be encouraged to take the COVID vaccine to prevent worsening complications,” he said. “As clinicians, we need to have a low threshold for testing for COVID in these patients … and be proactive in treatment to prevent worsening of symptoms.”
Though both IBD and COVID involve inflammation, the researchers said that it has been unclear whether there is a higher risk of severe COVID in IBD patients compared with those without the condition.
They therefore analyzed data from the 2020 Nationwide Inpatient Sample, which included 1,678,995 patients hospitalized with a diagnosis of COVID-19. After excluding records that lacked mortality and demographic data, the remaining patients included 91,608 with a diagnosis of IBD and 1,435,197 without IBD. About half the patients were women (52.2%), most were white (73.4%), and just over half had Medicare (54.6%).
The researchers examined incidence of shock, sepsis, AKI, blood transfusion, mechanical ventilation, and death. They adjusted their findings for patients’ age, sex, race, primary insurance, median income, and comorbidities, as well as for the region and size (based on beds) of the hospital where the patient was treated.
Disclosures
The study had no external funding, and the authors reported no disclosures.
Schwartz reported consulting for AbbVie, Avobis Bio, Bristol Myers Squibb, Gilead, Janssen, and Takeda, and serving on a data and safety monitoring board for Tract Therapeutics.
Primary Source
Crohn’s & Colitis Congress
Source Reference: Iqbal H, et al “The burden of inflammatory bowel disease on COVID-19 hospitalizations: a nationwide analysis” CCC 2024; Poster 034.
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