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Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study
  1. Cristina Bezzio1,
  2. Simone Saibeni1,
  3. Angela Variola2,
  4. Mariangela Allocca3,4,
  5. Alessandro Massari5,
  6. Viviana Gerardi6,
  7. Valentina Casini7,
  8. Chiara Ricci8,
  9. Fabiana Zingone9,
  10. Arnaldo Amato10,
  11. Flavio Caprioli11,12,
  12. Marco Vincenzo Lenti13,
  13. Chiara Viganò14,
  14. Marta Ascolani15,
  15. Fabrizio Bossa16,
  16. Fabiana Castiglione17,
  17. Claudio Cortelezzi18,
  18. Laurino Grossi19,
  19. Monica Milla20,
  20. Daniela Morganti21,
  21. Luca Pastorelli22,
  22. Davide Giuseppe Ribaldone23,
  23. Alessandro Sartini24,
  24. Alessandra Soriano25,
  25. Gianpiero Manes26,
  26. Silvio Danese3,4,
  27. Massimo Fantini27,
  28. Alessandro Armuzzi28,29,
  29. Marco Daperno30,
  30. Gionata Fiorino3,4
  31. on behalf of Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD)
  1. 1 Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
  2. 2 IBD Unit, Don Calabria Sacred Heart Hospital, Negrar, Veneto, Italy
  3. 3 IBD Center, Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
  4. 4 Department of Biomedical Sciences, Humanitas University, Milan, Italy
  5. 5 Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milano, Lombardia, Italy
  6. 6 Medicine, Gastroenterology and Digestive Endoscopy Department, Poliambulanza Brescia Hospital, Brescia, Lombardia, Italy
  7. 7 UOC Gastroenterology and Digestive Endoscopy, ASST Bergamo Est, Seriate, Lombardia, Italy
  8. 8 Gastroenterology Unit, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
  9. 9 Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Veneto, Italy
  10. 10 Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
  11. 11 Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
  12. 12 Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia, Italy
  13. 13 First Department of Internal Medicine, Università degli Studi di Pavia, Pavia, Lombardia, Italy
  14. 14 Gastroenterology Unit, Azienda Ospedaliera San Gerardo, Monza, Lombardia, Italy
  15. 15 Gastroenterology Unit, Ospedale Santa Maria di Ca Foncello, Treviso, Veneto, Italy
  16. 16 Division of Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
  17. 17 Gastroenterology, Federico II University Hospital, Napoli, Campania, Italy
  18. 18 Gastroenterology Uniit, ASST dei Sette Laghi, Varese, Lombardia, Italy
  19. 19 Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy
  20. 20 Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
  21. 21 Gastreonterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
  22. 22 Gastroenterology Unit, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
  23. 23 Division of Gastroenterology, Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
  24. 24 Internal Medicine, Gastroenterology Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
  25. 25 Gastroenterology Division, Arcispedale S Maria Nuova, Reggio Emilia, Emilia-Romagna, Italy
  26. 26 Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
  27. 27 Unit of Gastroenterology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
  28. 28 IBD Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  29. 29 Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Lazio, Italy
  30. 30 Gastroenterology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
  1. Correspondence to Dr Cristina Bezzio, Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy; cribezzio03{at}yahoo.it

Abstract

Objectives COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear.

Design This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death).

Results Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death.

Conclusions Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.

  • IBD
  • epidemiology

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Footnotes

  • Twitter @angela.variola, @rinogrossi62, @Max_Fantini

  • Correction notice This article has been corrected since it published Online First. Affiliation 3 has been updated.

  • Contributors CB, SS planning the study, drafting the article, analysis and interpretation of data. GF drafting article, analysis and interpretation of data. All other authors: data collections, critical revision of article for important intellectual content. All authors approved the final version of the manuscript including authorship list.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CB received lecture fees from Takeda, AbbVie and Janssen. SS received lecture fees from Takeda Pharmaceuticals and Janssen Pharmaceuticals and served as a consultant and a member of Advisory Boards for AbbVie and Janssen Pharmaceuticals. AV received lecture fees from Takeda and AbbVie and served as consultant for MSD, Pfizer and Janssen. MA received consulting fees from Nikkiso Europe and lecture fees from Janssen, Abbvie and Pfizer. CR reports personal fee from Abbvie, Janssen Cilag, MSD, Recordati, Takeda and Vifor. FC served as consultant and a member of advisory board for Mundipharma, AbbVie, MS&D, Takeda, Janssen, Roche, Celgene and received lecture fees from AbbVie, Amgen, Ferring, Takeda, Allergy Therapeutics and unrestricted research grants from Giuliani, Sofar, MSD, Takeda, AbbVie. FB served as a member of advisory board for Biogen and Janssen, Takeda, Celgene, Mundipharma, AbbVie and MSD. FC served as consultant and a member of advisory board for Mundipharma, AbbVie, MS&D, Takeda, Janssen, Roche, Celgene and received lecture fees from AbbVie, Amgen, Ferring, Takeda, Allergy Therapeutics. DGR served as consultant and received lecture fees from Janssen, Ferring, Errekappa. SD served as a speaker, consultant and advisory board member for Schering-Plough, Abbott (AbbVie) Laboratories, Merck, UCB Pharma, Ferring, Cellerix, Millenium Takeda, Nycomed, Pharmacosmos, Actelion, Alfa Wasserman, Genentech, Grunenthal, Pfizer, AstraZeneca, Novo Nordisk, Cosmo Pharmaceuticals, Vifor and Johnson and Johnson. MCF received fees as member of advisory boards and participation to sponsored symposia from AbbVie, Takeda, Jannsen-Cilag, Pfizer, Sandoz. AA served as a consultant for AbbVie, Allergan, Amgen, Biogen, Bristol Myers Squibb, Celgene, Celltrion, Ferring, Gilead, Janssen, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sandoz and Takeda; MD served as a speaker, consultant and advisory board member for AbbVie, Takeda, Janssen, Norgine, Pfizer, MSD, Celltrion, Roche, Gilead, Bioclinica, Ferring, SOFAR, Chiesi, Zambon. GF received consultancy fees from Ferring, MSD, AbbVie, Takeda, Janssen, Amgen, Sandoz, Samsung Bioepis, Celltrion.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the IG-IBD Scientific Committee and by the Coordinating Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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