S770 Risk of Cardiovascular, Thrombotic and Renal Complications After COVID-19 in Patients With Inflammatory Bowel Disease: A Propensity-Matched Cohort Study

Abstract

Introduction: Studies have demonstrated that patients with Coronavirus disease 2019 (COVID-19) are at an increased risk of incident cardiovascular disease (CVD) including cerebrovascular disease, dysrhythmias, ischemic heart disease, myocarditis, pericarditis, heart failure and thromboembolic disease. Renal complications are also frequently reported in patients with COVID-19. Little is known regarding the short and long-term risk of COVID-19 related complications in patients with inflammatory bowel disease (IBD) Methods: We compared the 1 year risk of cardiac complications (arrhythmias, heart failure, myocarditis and pericarditis), venous thromboembolism (VTE), peripheral artery disease (PAD), ischemic stroke and acute kidney injury (AKI) in patients between IBD and non-IBD cohort after COVID-19 using TriNetX, a multi-institutional database. Sub-group analysis was performed based on vaccination status, disease activity and IBD medications. Active disease was defined as patients requiring IV or PO steroids or initiation of new biologic agent within 6 months prior to diagnosis of COVID-19. Patients with stable disease were steroid free or were not initiated on new biologic for at least 1 year prior to diagnosis of COVID-19. 1:1 propensity-score matching was performed for age, gender, race, ethnicity and all major risk factors of COVID-19 between all cohorts. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated. Results: The IBD cohort (n = 8,773) had an increased risk for cardiac complications (aOR 1.52, 95% CI 1.33 – 1.73), VTE (1.77, 1.53-2.04), ischemic stroke (2.04, 1.74 – 2.38), AKI (1.34, 1.14 – 1.58) and PAD (1.70, 1.34 – 2.15) after COVID-19 compared to non-IBD cohort. There was no difference between the vaccinated IBD cohort (≥2 vaccine doses) and vaccinated non-IBD cohort for composite outcome of CVD, VTE and AKI (aOR 1.28, 95% CI 0.52 – 3.15). Patients with active disease and COVID19 infection had a higher risk for cardiac complications, VTE and AKI (Figure). There was no difference in the risk of CVD, VTE or AKI in IBD patients on tumor necrosis factor inhibitor (TNFi), immunomodulators, non-TNFi and chronic prednisone compared to patients on 5-aminosalicyclic acid (5-ASA) (Table). Conclusion: Patients with IBD who are unvaccinated or with active disease are at an increased risk for CVD, thrombotic and renal complications after COVID-19. These patients may benefit from close follow up and aggressive CVD risk factor modification.Figure 1.: 1 year risk of CVD, thrombotic and renal complications in IBD patients after COVID-19 based on disease activity. Table 1. - Risk of CVD, thrombotic and renal complications after COVID-19 in IBD patients on TNFi, non-TNFi, chronic steroids and immunomodulators compared to 5-ASA Complication IBD medication (%) OR 95% CI TNFi 5-ASA Composite 10.79 10.83 0.99 0.64 – 1.52 Cardiac complication 8.36 7.52 1.12 0.70 – 1.77 VTE 4.60 3.72 1.24 0.70 – 2.22 Ischemic stroke 4.87 4.15 1.18 0.68 – 2.04 PAD 2.33 1.56 1.5 0.67 – 3.38 AKI 2.86 3.17 0.89 0.46 – 1.74 Immunomodulators 5-ASA Composite 14.14 14.06 1 0.68 – 1.47 Cardiac complication 8.50 11.30 0.72 0.48 – 1.08 VTE 6.90 6.50 1.06 0.71 – 1.60 Ischemic stroke 6.45 4.81 1.36 0.87 – 2.12 PAD 2.48 2.13 1.17 0.62 – 2.18 AKI 5.93 4.74 1.26 0.80 – 1.98 Non-TNFi 5-ASA Composite 12.50 12.50 1 0.55 – 1.79 Cardiac complication 8.15 11.62 0.67 0.36 – 1.24 VTE 4.74 3.86 1.24 0.54 – 2.81 Ischemic stroke 3.44 5.28 0.64 0.28 – 1.45 PAD 3.24 3.24 1 0.41 – 2.45 AKI 4.61 3.49 1.33 0.57 – 3.09 Steroid 5-ASA Composite 17.4 14.9 1.20 0.91 – 1.58 Cardiac complication 12.9 12.4 1.04 0.80 – 1.137 VTE 7.6 7.2 1.05 0.79 – 1.40 Ischemic stroke 7.9 6.07 1.33 0.99 – 1.78 PAD 2.3 2.1 1.09 0.69 – 1.74 AKI 7.01 5.97 1.18 0.87 – 1.61