Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

Bezzio, Cristina; Saibeni, Simone; Variola, Angela; Allocca, Mariangela; Massari, Alessandro; Gerardi, Viviana; Casini, Valentina; Ricci, Chiara; Zingone, Fabiana; Amato, Arnaldo; Caprioli, Flavio; Lenti, Marco Vincenzo; Viganò, Chiara; Ascolani, Marta; Bossa, Fabrizio; Castiglione, Fabiana; Cortelezzi, Claudio; Grossi, Laurino; Milla, Monica; Morganti, Daniela; Pastorelli, Luca; Ribaldone, Davide Giuseppe; Sartini, Alessandro; Soriano, Alessandra; Manes, Gianpiero; Danese, Silvio; Fantini, Massimo; Armuzzi, Alessandro; Daperno, Marco; Fiorino, Gionata

OBJECTIVES: COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. DESIGN: This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). RESULTS: Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. CONCLUSIONS: Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.