Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

Abstract

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case–control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March–July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3–5.9), occupational risk (OR: 2.9; 95%CI: 1.8–4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2–2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09–0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

“…Initially, SARS-CoV-2 vaccines caused hesitancy in the IBD, mainly due to fear of poor response and safety concerns. IBD represents impaired immune function due to the disease and the therapies used to control this illness[ 60 ]. Jena et al [ 164 ] in a systematic review and meta-analysis, analyzed the response to complete vaccination in IBD patients.…”

“…In IBD patients, as in the general population, age and comorbidities increase the risk of severe COVID-19 and disease-related mortality[ 45 , 59 ]. A prospective observational study that included 482 patients confirmed that age over 60 years was correlated with severe COVID-19 [odds ratio (OR) = 4.59, 95%CI: 1.3-15.9] and was an independent risk factor related to death (OR = 7.1, 95%CI: 1.8-27.4), as to have two or more comorbidities (OR = 3.9, 95%CI: 1.3-11.6)[ 60 ]. Wetwittayakhlang et al [ 61 ] examined a cohort of 3516 IBD patients, of whom 82 were diagnosed with COVID-19 infection, and they observed that age over 55 years was an independent risk factor for developing severe COVID-19.…”