Individuals with IBD Hospitalized for COVID-19 at High Risk for Shock, Organ Injury Suggests National Analysis

Individuals hospitalized for COVID-19 infection who have a history of inflammatory bowel disease (IBD) may be at significantly greater risk of adverse outcomes including sepsis and acute kidney injury (AKI), according to new research results. They may not be at greater risk, however, of requiring mechanical ventilation during hospitalization or of death.

The findings were presented as an oral abstract at the 2024 Crohn’s & Colitis Congress, January 25-27, 2024, in Las Vegas, NV, by Rakahn Haddadin, MD, of the department of internal medicine at the University of California San Francisco, in Fresno, CA.

IBD and COVID-19 are both characterized by a pro-inflammatory state and there are data to suggest that COVID-19 infection may be more severe in those with either Crohn disease (CD) or ulcerative colitis (UC), according to Haddadin and colleagues. Their study was performed to assess whether clinical outcomes are indeed worse in individuals with IBD who are hospitalized with SARS-CoV-2.

Researchers used the 2020 Nationwide Inpatient Sample to identify persons with a diagnosis of COVID-19 who were then stratified by the presence of IBD. They collected data on the incidence of negative outcomes identified as shock, sepsis, AKI, blood transfusion, mechanical ventilation, and death. Other variables included in the analysis were age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities, according to the study abstract. Multivariate regression analysis was used to explore the relationship between outcomes among inpatients with COVID-19 and presence of IBD.

FINDINGS

According to the abstract, the final cohort for the analysis numbered 1 526 805; of this group, 6% had a concurrent diagnosis of either CD or UC. Slightly more than half (52.2%) of the participants with IBD were women, 73.4% were White, and 54.6% were covered by Medicare insurance.

Of the adverse outcomes studied, Haddadin et al reported that a history of IBD was associated with an adjusted increase in the risk for sepsis of 15% (aOR 1.15; P = .01); for shock of 26% (aOR 1.26; P = .007); and for AKI of 25% (aOR 1.25; P < .001). The researchers found no difference in the risk of requiring mechanical ventilation or of in-patient mortality between individuals with IBD or without the condition.

In the abstract’s conclusion, the investigators urge “diligent” evaluation of any person with UC or CD who becomes infected with COVID given the potential for predisposition to shock and organ injury. They recommend additional research to better understand why the comorbid illnesses do not seem to be associated with ventilator-dependent respiratory failure or death.

Source: Iqbal H, Haddadin R, Haidary H, Zhang P, Prajapati P. The burden of inflammatory bowel disease on COVID-19 hospitalization: a nationwide analysis. Abstract presented at: 2024 Crohn’s & Colitis Conference; January 25-27, 2024; Las Vegas, NV. Accessed January 25, 2024.