Inflammatory bowel disease and COVID-19 outcomes: a meta-analysis

Abstract

There is conflicting evidence concerning the effect of inflammatory bowel disease (IBD) on COVID-19 incidence and outcome. Hence, we aimed to evaluate the published evidence through a systematic review process and perform a meta-analysis to assess the association between IBD and COVID-19. A compressive literature search was performed in PubMed/Medline, Scopus, Embase, and Cochrane Library from inception to July 2021. A snowball search in Google, Google Scholar, Research Gate, and MedRxiv; and bibliographic research were also performed to identify any other relevant articles. Quantitative observational studies such as cohort, cross-sectional, and case–control studies that assessed the incidence, risk, and outcomes of COVID-19 among the adult IBD patients published in the English language, were considered for this review. The incidence and risk of COVID-19, COVID-19 hospitalization, the severity of COVID-19, and mortality were considered as the outcomes of interest. The Joanna Briggs Institute critical appraisal checklist was used for quality assessment. A subgroup and sensitivity analysis were performed to explore the heterogeneity and robustness of the results, respectively. A total of 86 studies out of 2828 non-duplicate records were considered for this meta-analysis. The studies were single or multicentric internationally from settings such as IBD centres, medical colleges, hospitals, or from the general public. Most of the studies were observed to be of good quality with an acceptable risk of bias. The pooled prevalence of COVID-19, COVID-19 hospitalization, severe COVID-19, and mortality in the IBD population were 6.10%, 10.63%, 40.43%, and 1.94%, respectively. IBD was not significantly (p > 0.05) associated with the risk of COVID-19, COVID-19 hospitalization, severe COVID-19, and mortality. In contrast, ulcerative colitis was significantly associated with a higher risk of COVID-19 (OR 1.37; p = 0.01), COVID-19 hospitalization (OR 1.28; p < 0.00001), and severe COVID-19 (OR 2.45; p < 0.0007). Crohn’s disease was significantly associated with a lesser risk of severe COVID-19 (OR 0.48; p = 0.02). Type of IBD was a potential factor that might have contributed to the higher level of heterogeneity. There was a significant association between ulcerative colitis and increased risk of COVID-19, COVID-19 hospitalization, and severe COVID-19 infection. This association was not observed in patients with Crohns' disease or in those diagnosed non-specifically as IBD.

The incidence and clinical characteristics of COVID-19 in children with IBD during the Omicron Wave: a single-center experience in China

“…Some studies indicate a higher risk of COVID-19 and mortality in patients with IBD, while some had the opposite conclusion [16][17][18][19] . In our cohort, the incidence of COVID-19 in IBD population is much lower than it in the general population [20] , and a relatively small proportion of patients requiring hospitalization. No patient got severe COVID-19, and no deaths have been observed.…”

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

“…They attributed this difference to the severe nature of disease, higher level of immunosuppression and higher level of hospitalization in patients with UC. Factors such as advanced age, unvaccinated status, use of oral steroids and proton pump inhibitors, female gender and obesity, as well as other co-morbid conditions like diabetes, hypertension and asthma were also associated with a higher risk of severe COVID-19 infection [ 4 ]. In terms of therapies, chronic use of mesalamine resulted in increased hospitalizations, ICU admissions, and mortality in COVID-19 patients [ 3 ].…”

“…Recent studies have shown conflicting results on the severity of COVID-19 in IBD patients, with some studies reporting higher rates of hospitalization and mortality, while others reporting no differences [ 2 , 3 ]. Furthermore, the literature also reports that patients with IBD have a comparable disease course as the overall population [ 4 , 5 ]. These inconsistencies in the literature highlight the need for further investigation to better elucidate the relationship between IBD and COVID-19 viral illness.…”

Gastrointestinal Manifestations of SARS-CoV-2: Transmission, Pathogenesis, Immunomodulation, Microflora Dysbiosis, and Clinical Implications

“…Recently, several studies have reported that SARS-CoV-2 infection may lead to a de novo UC in patients without GI symptoms before the infection [ 54 , 55 ]. The connection between COVID-19 and IBD was investigated in a recent meta-analysis, which analyzed the overall incidence of COVID-19, hospitalization due to COVID-19, severe COVID-19 cases, and mortality in patients with IBD [ 56 ], and identified notable correlations between UC and heightened susceptibility to COVID-19, COVID-19-related hospitalization, and severe cases in COVID-19 patients. Conversely, they also discovered that CD is noticeably linked with a reduced risk of severe COVID-19.…”