Inflammatory bowel disease and risk of severe COVID‐19: A nationwide population‐based cohort study in Sweden

Ludvigsson, Jonas F.; Axelrad, Jordan E.; Halfvarson, Jonas; Khalili, Hamed; Larsson, Emma; Lochhead, Paul; Roelstraete, Björn; Simon, Tracey G.; Söderling, Jonas; Olén, Ola

doi:10.1002/ueg2.12049

Cited by 44 publications

(64 citation statements)

References 45 publications

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“…Data from the SECURE registry, a prospective, international, and collaborative database, showed that the sex‐standardized mortality ratio was similar to that of the general population, 66 but updated data suggested that mortality in IBD might be higher (data not published) 67 . However, a separate multicenter analysis of 232 patients did not find differences in hospitalization or mortality risk 68,69 . In this context, the risk of severe COVID‐19 in patients with IBD (defined as ICU admission, use of mechanical ventilation, or death) seems to be driven by the same risk factors as in the general population.…”

Section: Covid‐19 In Ibdmentioning

confidence: 96%

“… 67 However, a separate multicenter analysis of 232 patients did not find differences in hospitalization or mortality risk. 68 , 69 In this context, the risk of severe COVID‐19 in patients with IBD (defined as ICU admission, use of mechanical ventilation, or death) seems to be driven by the same risk factors as in the general population. While age appears to confer additional prognostic risk as in the general population, this risk is not increased in IBD per se , 64 , 66 , 70 , 71 as observed in subjects with concomitant non‐IBD comorbidities.…”

Section: Covid‐19 In Ibdmentioning

confidence: 99%

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COVID‐19 in gastroenterology: Where are we now? Current evidence on the impact of COVID‐19 in gastroenterology

et al. 2021

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Background The COVID‐19 pandemic has created unprecedented challenges in all fields of society with social, economic, and health‐related consequences worldwide. In this context, gastroenterology patients and healthcare systems and professionals have seen their routines changed and were forced to adapt, adopting measures to minimize the risk of infection while guaranteeing continuous medical care to chronic patients. Objective At this point, it is important to evaluate the impact of the pandemic on this field to further improve the quality of the services provided in this context. Methods/Results/Conclusion We performed a literature review that summarizes the main aspects to consider in gastroenterology, during the pandemic crisis, and includes a deep discussion on the main changes affecting gastroenterology patients and healthcare systems, anticipating the pandemic recovery scenario with future practices and policies.

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Section: Covid‐19 In Ibdmentioning

confidence: 96%

Section: Covid‐19 In Ibdmentioning

confidence: 99%

COVID‐19 in gastroenterology: Where are we now? Current evidence on the impact of COVID‐19 in gastroenterology

et al. 2021

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“…Studies that reported a higher incidence are essentially three, as showed in Table 1 [ 10 , 12 , 13 ]. The study of Carparelli et al involved 600 IBD patients, both children and adults, 25 of whom were diagnosed with COVID-19 (no cases among pediatric patients).…”

Section: Is Sars-cov-2 Infection Incidence Increased In Inflammatory Bowel Diseases Affected Patients?mentioning

confidence: 99%

“…Although some studies have found a higher risk of hospitalization in IBD patients [ 10 , 11 , 13 ] ( Table 1 ), works that do not support this hypothesis are more numerous. Infection lethality was found to be 1% against 9% of the general population in a study by Allocca et al [ 20 ].…”

Section: Outcome: Which Risks For Inflammatory Bowel Diseases Affected Patients?mentioning

confidence: 99%

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

et al. 2021

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Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

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“…In a recent Swedish population-based study, IBD patients were at an increased risk of hospitalization for COVID-19 compared to the general population, even after adjusting for comorbidities [ 13 ]. Remarkably, the subsequent risk for intensive care unit (ICU) admission or death was comparable with a low absolute risk of severe COVID-19 in IBD patients [ 13 ]. To guide vaccination strategies against SARS-CoV-2, it is crucial to exactly delineate populations at risk for a severe course of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Severe COVID-19 in inflammatory bowel disease patients in a population-based setting

et al. 2021

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Objective Data on the course of severe COVID-19 in inflammatory bowel disease (IBD) patients remains limited. We aimed to determine the incidence rate and clinical course of severe COVID-19 in the heavily affected South-Limburg region in the Netherlands. Methods All COVID-19 patients admitted to the only two hospitals covering the whole South-Limburg region between February 27, 2020 and January 4, 2021 were included. Incidence rates for hospitalization due to COVID-19 were determined for the IBD (n = 4980) and general population (n = 597,184) in South-Limburg. Results During a follow-up of 4254 and 510,120 person-years, 20 IBD patients (0.40%; 11 ulcerative colitis (UC), 9 Crohn’s disease (CD)) and 1425 (0.24%) patients from the general population were hospitalized due to proven COVID-19 corresponding to an incidence rate of 4.7 (95% Confidence interval (CI) 3.0–7.1) and 2.8 (95% CI 2.6–2.9) per 1000 patient years, respectively (Incidence rate ratio: 1.68, 95% CI 1.08–2.62, p = 0.019). Median age (IBD: 63.0 (IQR 58.0–75.8) years vs. general population: 72.0 (IQR 62.0–80.0) years, p = 0.10) and mean BMI (IBD: 24.4 (SD 3.3) kg/m2 vs. general population 24.1 (SD 4.9) kg/m2, p = 0.79) at admission were comparable in both populations. As for course of severe COVID-19, similar rates of ICU admission (IBD: 12.5% vs. general population: 15.7%, p = 1.00), mechanical ventilation (6.3% vs. 11.2%, p = 1.00) and death were observed (6.3% vs. 21.8%, p = 0.22). Conclusion We found a statistically significant higher rate of hospitalization due to COVID-19 in IBD patients in a population-based setting in a heavily impacted Dutch region. This finding reflects previous research that showed IBD patients using systemic medication were at an increased risk of serious infection. However, although at an increased risk of hospitalization, clinical course of severe COVID-19 was comparable to hospitalized patients without IBD.

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Inflammatory bowel disease and risk of severe COVID‐19: A nationwide population‐based cohort study in Sweden

Cited by 44 publications

References 45 publications

COVID‐19 in gastroenterology: Where are we now? Current evidence on the impact of COVID‐19 in gastroenterology

COVID‐19 in gastroenterology: Where are we now? Current evidence on the impact of COVID‐19 in gastroenterology

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

Severe COVID-19 in inflammatory bowel disease patients in a population-based setting

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