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Article ; Online: Bowel necrosis in patient with severe case of COVID-19: a case report.

Soeselo, Daniel Ardian / Hambali, Wirawan / Theresia, Sandy

2021 Volume 21, Issue 1, Page(s) 97

Abstract: ... We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and ... Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high ... Background: In patients who are critically ill with COVID-19, multiple extrapulmonary ...

Abstract	Background: In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. Case presentation: We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. Conclusions: Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.
MeSH term(s)	Aged ; COVID-19/complications ; COVID-19/therapy ; Humans ; Intestinal Diseases/pathology ; Intestinal Diseases/virology ; Male ; Necrosis ; Severity of Illness Index
Language	English
Publishing date	2021-02-22
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-021-01104-7
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Article: Implications of COVID-19 in Acute Mesenteric Ischemia and Bowel Necrosis: A Case Report.

Burrows, Kelsey R / Remington, David L / Cappola, James J

Cureus

2023 Volume 15, Issue 10, Page(s) e47867

Abstract: ... and laboratory workup even in patients without a current COVID-19 infection or predisposing thrombotic ... of the coronavirus pandemic in 2019; however, the specific relationship between COVID-19 and thrombus formation ... the resolution of her COVID-19 symptoms. The high rates of morbidity and mortality linked to AMI underpin ...

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to provoke a state of hypercoagulability that may lead to devastating consequences. This has been well established since the onset of the coronavirus pandemic in 2019; however, the specific relationship between COVID-19 and thrombus formation remains poorly understood. There has been increasing documentation of gastrointestinal (GI) complications in patients infected with the virus, including potentially lethal acute mesenteric ischemia (AMI), regardless of prior history of GI disease or risk factors for hypercoagulable states. Not only is mesenteric ischemia difficult to diagnose but it is also associated with high rates of morbidity and mortality, warranting prompt identification and treatment to improve clinical outcomes. We herein present a case of diffuse intestinal necrosis secondary to mesenteric thrombus formation in a previously healthy female five days after the resolution of her COVID-19 symptoms. The high rates of morbidity and mortality linked to AMI underpin the need for clinicians to maintain a high index of suspicion for thrombotic complications of COVID, even in healthy patients. This case emphasizes the importance of a thorough history-taking, physical examination, and laboratory workup even in patients without a current COVID-19 infection or predisposing thrombotic risk factors. Additionally, it suggests that the hypercoagulable state associated with a COVID-19 infection may persist after the primary COVID-19 symptoms have resolved.
Language	English
Publishing date	2023-10-28
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.47867
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Article ; Online: Severe Activity of Inflammatory Bowel Disease is a Risk Factor for Severe COVID-19.

Macaluso, Fabio Salvatore / Giuliano, Alessandra / Fries, Walter / Viola, Anna / Abbruzzese, Alfredo / Cappello, Maria / Giuffrida, Enrica / Carrozza, Lucio / Privitera, Antonino Carlo / Magnano, Antonio / Ferracane, Concetta / Scalisi, Giuseppe / Minissale, Maria Giovanna / Giangreco, Emiliano / Garufi, Serena / Bertolami, Carmelo / Cucinotta, Ugo / Graziano, Francesco / Casà, Angelo /

Renna, Sara / Teresi, Giulia / Rizzuto, Giulia / Mannino, Mariella / Maida, Marcello / Orlando, Ambrogio

Inflammatory bowel diseases

2022 Volume 29, Issue 2, Page(s) 217–221

Abstract: ... CI, 1.104-164.182; P = .042) were independent predictors of COVID-19-related pneumonia, while severe ... of severe COVID-19, a composite endpoint defined as the need for respiratory assistance or death. A trend ... independent risk factor for severe COVID-19. ...

Abstract	Background: Data from the first wave of the coronavirus disease 2019 (COVID-19) pandemic suggested that patients with inflammatory bowel disease (IBD) are not at higher risk of being infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population and that a worse prognosis is not associated with immunomodulatory drugs, with the possible exception of systemic steroids. Methods: This retrospective, observational study included consecutive IBD patients from the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) cohort who had a SARS-CoV-2 infection diagnosis (polymerase chain reaction-confirmed presence of the viral genome in a nasopharyngeal swab) during the second COVID-19 pandemic wave (September 2020 to December 2020). Data regarding demographics, IBD features and treatments, and comorbidities were analyzed in correlation with COVID-19 clinical outcomes. Results: Data on 122 patients (mean age, 43.9 ± 16.7 years; males, 50.0%; Crohn's disease, 62.3%; ulcerative colitis, 37.7%) were reported. Twelve patients developed COVID-19-related pneumonia (9.8%), 4 (3.3%) required respiratory assistance (nonmechanical ventilation or orotracheal intubation), and 4 died (case fatality rate, 3.3%). In a multivariable analysis, age (odds ratio [OR], 1.034; 95% CI, 1.006-1.147; P = .032) and severe IBD activity (OR, 13.465; 95% CI, 1.104-164.182; P = .042) were independent predictors of COVID-19-related pneumonia, while severe IBD activity (OR, 15.359; 95% CI, 1.320-178.677; P = .030) was the only independent predictor of severe COVID-19, a composite endpoint defined as the need for respiratory assistance or death. A trend towards a protective role of tumor necrosis factor α inhibitors on pneumonia development was reported (P = .076). Conclusions: In this cohort of patients with IBD and SARS-CoV-2 infection, severe IBD activity was the only independent risk factor for severe COVID-19.
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; COVID-19/complications ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics ; Retrospective Studies ; Inflammatory Bowel Diseases/therapy ; Risk Factors
Language	English
Publishing date	2022-04-06
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	1340971-2
ISSN	1536-4844 ; 1078-0998
ISSN (online)	1536-4844
ISSN	1078-0998
DOI	10.1093/ibd/izac064
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Article ; Online: Superior mesenteric artery thrombosis and small bowel necrosis

Ayman Nada, MD, PhD / Amr Shabana, MD, FRCR / Amr Elsaadany, MD, FRCR, EBIR / Ahmed Abdelrahman, MD / Ayman H. Gaballah, MD, FRCR

Radiology Case Reports, Vol 17, Iss 3, Pp 821-

An uncommon thromboembolic manifestation in COVID-19 pneumonia

2022 Volume 824

Abstract: Thromboembolism is a recognized complication in patients with COVID-19 infection. It is believed ... an uncommon thromboembolic complication of the superior mesenteric artery in a 49-year-old male with COVID-19 ... pneumonia. The patient also developed segmental infarct of his renal transplant. Patients with SARS-COV-2 ...

Abstract	Thromboembolism is a recognized complication in patients with COVID-19 infection. It is believed that coagulopathy results secondary to severe inflammatory response syndrome with release of cytokines, viral activation of coagulation cascade or viral related vasculitis. Both arterial and venous thromboembolic complications have been described, however venous thromboembolic complications are much far common. We present an uncommon thromboembolic complication of the superior mesenteric artery in a 49-year-old male with COVID-19 pneumonia. The patient also developed segmental infarct of his renal transplant. Patients with SARS-COV-2 infection should be closely evaluated and monitored for the development of thromboembolic complications. Prompt evaluation with CT angiography of suspected thromboembolism could help early diagnosis and treatment which can reflect better patients’ outcomes
Keywords	COVID-19 ; Thromboembolism ; Mesenteric ischemia ; CT abdomen and pelvis ; Renal infarct ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: Bowel ischemia as onset of COVID-19 in otherwise asymptomatic patients with persistently negative swab.

Zamboni, Paolo / Bortolotti, Daria / Occhionorelli, Savino / Traina, Luca / Neri, Luca Maria / Rizzo, Roberta / Gafà, Roberta / Passaro, Angelina

Journal of internal medicine

2021 Volume 291, Issue 2, Page(s) 224–231

Abstract: ... This is the first case report in which patients with severe intestinal symptoms presented a marked SARS ... for Coronavirus Disease 2019 (COVID-19) and with persistently real-time polymerase chain reaction negative ... the usual manifestations of COVID-19, and repeated pharyngeal swabs tested negative. They underwent ...

Abstract	Background: Asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can develop hypercoagulable conditions and acute vascular events. The objective of this study is to determine whether SARS-CoV-2 was present in resected specimens from patients with acute bowel ischemia, but asymptomatic for Coronavirus Disease 2019 (COVID-19) and with persistently real-time polymerase chain reaction negative pharyngeal swab. Methods: Three consecutive patients presented severe abdominal symptoms due to extensive ischemia and necrosis of the bowel, with co-existent thrombosis of abdominal blood vessels. None had the usual manifestations of COVID-19, and repeated pharyngeal swabs tested negative. They underwent emergency surgery with intestinal resection. Immunohistochemical testing for SARS-CoV-2 on resected tissue was performed. Results: All tested samples were strongly positive for SARS-CoV-2. Conclusions: This is the first case report in which patients with severe intestinal symptoms presented a marked SARS-CoV-2 positivity in the resected tissues, without any usual clinical manifestations of COVID-19. These results suggest that the patients might be infected with SARS-CoV-2 presenting acute abdominal distress but without respiratory or constitutional symptoms.
MeSH term(s)	COVID-19/pathology ; Humans ; Intestine, Large/pathology ; Ischemia/diagnosis ; Ischemia/virology ; Necrosis ; Real-Time Polymerase Chain Reaction ; SARS-CoV-2 ; Thrombosis
Language	English
Publishing date	2021-10-08
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13385
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Article: Superior mesenteric artery thrombosis and small bowel necrosis: An uncommon thromboembolic manifestation in COVID-19 pneumonia.

Nada, Ayman / Shabana, Amr / Elsaadany, Amr / Abdelrahman, Ahmed / Gaballah, Ayman H

Radiology case reports

2021 Volume 17, Issue 3, Page(s) 821–824

Abstract	Thromboembolism is a recognized complication in patients with COVID-19 infection. It is believed that coagulopathy results secondary to severe inflammatory response syndrome with release of cytokines, viral activation of coagulation cascade or viral related vasculitis. Both arterial and venous thromboembolic complications have been described, however venous thromboembolic complications are much far common. We present an uncommon thromboembolic complication of the superior mesenteric artery in a 49-year-old male with COVID-19 pneumonia. The patient also developed segmental infarct of his renal transplant. Patients with SARS-COV-2 infection should be closely evaluated and monitored for the development of thromboembolic complications. Prompt evaluation with CT angiography of suspected thromboembolism could help early diagnosis and treatment which can reflect better patients' outcomes.
Language	English
Publishing date	2021-12-31
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2021.11.069
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Article ; Online: Transmembrane serine protease 2 and angiotensin-converting enzyme 2 anti-inflammatory receptors for COVID-19/inflammatory bowel diseases treatment.

Lashgari, Naser-Aldin / Momeni Roudsari, Nazanin / Momtaz, Saeideh / Abdolghaffari, Amir Hossein

World journal of gastroenterology

2021 Volume 27, Issue 46, Page(s) 7943–7955

Abstract: ... in patients with coronavirus disease 2019 (COVID-19). Currently, the ongoing COVID-19 pandemic caused serious ... inflammatory immunological responses that are efficient to encounter COVID-19. Current analysis elucidates ... the role of inflammation and immune responses during IBD infection with COVID-19 and provides a list ...

Abstract	Inflammatory bowel diseases (IBD) refer to a subgroup of chronic, progressive, long-term, and relapsing inflammatory disorders. IBD may spontaneously grow in the colon, and in severe cases may result in tumor lesions such as invasive carcinoma in inflamed regions of the intestine. Recent epidemiological reports indicate that old age and underlying diseases such as IBD contribute to severity and mortality in patients with coronavirus disease 2019 (COVID-19). Currently, the ongoing COVID-19 pandemic caused serious morbidity and mortality worldwide. It has also been shown that the transmembrane serine protease 2 is an essential factor for viral activation and viral engulfment. Generally, viral entry causes a 'cytokine storm' that induces excessive generation of proinflammatory cytokines/chemokines including interleukin (IL)-6, IL-2, IL-7, tumor necrosis factor-α, and interferon-γ. Future research could concentrate on developing inflammatory immunological responses that are efficient to encounter COVID-19. Current analysis elucidates the role of inflammation and immune responses during IBD infection with COVID-19 and provides a list of possible targets for IBD-regulated therapies in particular. Data from clinical,
MeSH term(s)	Angiotensin-Converting Enzyme 2 ; Anti-Inflammatory Agents ; COVID-19 ; Humans ; Inflammatory Bowel Diseases/therapy ; Neoplasm Recurrence, Local ; Pandemics ; SARS-CoV-2 ; Serine Proteases
Chemical Substances	Anti-Inflammatory Agents ; Serine Proteases (EC 3.4.-) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Language	English
Publishing date	2021-12-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v27.i46.7943
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Article ; Online: Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry.

Brenner, Erica J / Ungaro, Ryan C / Gearry, Richard B / Kaplan, Gilaad G / Kissous-Hunt, Michele / Lewis, James D / Ng, Siew C / Rahier, Jean-Francois / Reinisch, Walter / Ruemmele, Frank M / Steinwurz, Flavio / Underwood, Fox E / Zhang, Xian / Colombel, Jean-Frederic / Kappelman, Michael D

Gastroenterology

2020 Volume 159, Issue 2, Page(s) 481–491.e3

Abstract: ... with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients ... median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were ... comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD ...

Abstract	Background and aims: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. Methods: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. Results: 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.02), ≥2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2). Conclusions: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.
MeSH term(s)	Adrenal Cortex Hormones/adverse effects ; Adult ; Aged ; Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus Infections/chemically induced ; Coronavirus Infections/mortality ; Coronavirus Infections/virology ; Critical Care/statistics & numerical data ; Female ; Hospitalization/statistics & numerical data ; Humans ; Immunosuppressive Agents/adverse effects ; Inflammatory Bowel Diseases/drug therapy ; Inflammatory Bowel Diseases/mortality ; Inflammatory Bowel Diseases/virology ; Male ; Middle Aged ; Odds Ratio ; Pandemics ; Pneumonia, Viral/chemically induced ; Pneumonia, Viral/mortality ; Pneumonia, Viral/virology ; Population Surveillance ; Registries ; Respiration, Artificial/statistics & numerical data ; Risk Factors ; SARS-CoV-2 ; Sulfasalazine/adverse effects ; Tumor Necrosis Factor Inhibitors/adverse effects
Chemical Substances	Adrenal Cortex Hormones ; Immunosuppressive Agents ; Tumor Necrosis Factor Inhibitors ; Sulfasalazine (3XC8GUZ6CB)
Keywords	covid19
Language	English
Publishing date	2020-05-18
Publishing country	United States
Document type	Evaluation Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2020.05.032
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Article ; Online: Altered Intestinal ACE2 Levels Are Associated With Inflammation, Severe Disease, and Response to Anti-Cytokine Therapy in Inflammatory Bowel Disease.

Potdar, Alka A / Dube, Shishir / Naito, Takeo / Li, Katherine / Botwin, Gregory / Haritunians, Talin / Li, Dalin / Casero, David / Yang, Shaohong / Bilsborough, Janine / Perrigoue, Jacqueline G / Denson, Lee A / Daly, Mark / Targan, Stephan R / Fleshner, Phillip / Braun, Jonathan / Kugathasan, Subra / Stappenbeck, Thaddeus S / McGovern, Dermot P B

Gastroenterology

2020 Volume 160, Issue 3, Page(s) 809–822.e7

Abstract: ... of severe acute respiratory syndrome coronavirus 2 infection and potentially explain reports of reduced morbidity from coronavirus ... Background and aims: The host receptor for severe acute respiratory syndrome coronavirus 2 ... angiotensin-converting enzyme 2 (ACE2), is highly expressed in small bowel (SB). Our aim was to identify ...

Abstract	Background and aims: The host receptor for severe acute respiratory syndrome coronavirus 2, angiotensin-converting enzyme 2 (ACE2), is highly expressed in small bowel (SB). Our aim was to identify factors influencing intestinal ACE2 expression in Crohn's disease (CD), ulcerative colitis (UC), and non-inflammatory bowel disease (IBD) controls. Methods: Using bulk RNA sequencing or microarray transcriptomics from tissue samples (4 SB and 2 colonic cohorts; n = 495; n = 387 UC; n = 94 non-IBD), we analyzed the relationship between ACE2 with demographics and disease activity and prognosis. We examined the outcome of anti-tumor necrosis factor and anti-interleukin-12/interleukin-23 treatment on SB and colonic ACE2 expression in 3 clinical trials. Univariate and multivariate regression models were fitted. Results: ACE2 levels were consistently reduced in SB CD and elevated in colonic UC compared with non-IBD controls. Elevated SB ACE2 was also associated with demographic features (age and elevated body mass index) associated with poor coronavirus disease 2019 outcomes. Within CD, SB ACE2 was reduced in patients subsequently developing complicated disease. Within UC, colonic ACE2 was elevated in active disease and in patients subsequently requiring anti-tumor necrosis factor rescue therapy. SB and colonic ACE2 expression in active CD and UC were restored by anti-cytokine therapy, most notably in responders. Conclusions: Reduced SB but elevated colonic ACE2 levels in IBD are associated with inflammation and severe disease, but normalized after anti-cytokine therapy, suggesting compartmentalization of ACE2-related biology in SB and colonic inflammation. The restoration of ACE2 expression with anti-cytokine therapy might be important in the context of severe acute respiratory syndrome coronavirus 2 infection and potentially explain reports of reduced morbidity from coronavirus disease 2019 in IBD patients treated with anti-cytokines.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiotensin-Converting Enzyme 2/genetics ; Angiotensin-Converting Enzyme 2/metabolism ; Anti-Inflammatory Agents/adverse effects ; Anti-Inflammatory Agents/therapeutic use ; COVID-19/enzymology ; COVID-19/immunology ; COVID-19/virology ; Case-Control Studies ; Child ; Child, Preschool ; Colitis, Ulcerative/drug therapy ; Colitis, Ulcerative/enzymology ; Colitis, Ulcerative/genetics ; Colitis, Ulcerative/immunology ; Crohn Disease/drug therapy ; Crohn Disease/enzymology ; Crohn Disease/genetics ; Crohn Disease/immunology ; Databases, Genetic ; Female ; Gene Expression Regulation, Enzymologic ; Host-Pathogen Interactions ; Humans ; Intestines/drug effects ; Intestines/enzymology ; Intestines/immunology ; Male ; Middle Aged ; North America ; RNA, Messenger/genetics ; RNA, Messenger/metabolism ; Receptors, Virus/metabolism ; SARS-CoV-2/enzymology ; SARS-CoV-2/immunology ; Severity of Illness Index ; Treatment Outcome ; Tumor Necrosis Factor Inhibitors/adverse effects ; Tumor Necrosis Factor Inhibitors/therapeutic use ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; Tumor Necrosis Factor-alpha/metabolism ; Young Adult
Chemical Substances	Anti-Inflammatory Agents ; RNA, Messenger ; Receptors, Virus ; TNF protein, human ; Tumor Necrosis Factor Inhibitors ; Tumor Necrosis Factor-alpha ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Keywords	covid19
Language	English
Publishing date	2020-11-05
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2020.10.041
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Article: Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

Gastroenterology

Abstract: ... with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients ... men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients ... Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD ...

Abstract	BACKGROUND AND AIMS: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. METHODS: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. RESULTS: 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.02), ≥2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2). CONCLUSIONS: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #306282
Database	COVID19

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