THE BURDEN OF INFLAMMATORY BOWEL DISEASE ON COVID-19 HOSPITALIZATIONS: A NATIONWIDE ANALYSIS

Abstract

Abstract BACKGROUND Inflammatory bowel disease (IBD) is a chronic systemic inflammatory process with primarily gastrointestinal (GI) manifestations, and is comprised of Crohn’s disease (CD) and ulcerative colitis (UC). The COVID-19 pandemic was unprecedented global health crisis that had a profound impact on healthcare burden. Both IBD and COVID-19 are associated with a pro-inflammatory state, however, the relationship between the two disease states remains unclear. Some studies suggest that IBD patients may develop more severe COVID-19 infection. We aim to assess whether patients with a history of IBD have worse outcomes when hospitalized with COVID-19. METHODS Patients with a diagnosis of COVID-19 were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of IBD. Data were collected regarding incidence of shock, sepsis, acute kidney injury (AKI), blood transfusion, mechanical ventilation, and death. Other variables included age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between outcomes in patients hospitalized with COVID-19 and IBD was analyzed using multivariate regression analysis. RESULTS A total of 1,526,805 patients with a diagnosis of COVID-19 were included in the study. Of these, 91,608 (6.0%) had a concurrent diagnosis of either CD or UC. The majority of patients in the IBD group were female (52.2%), White (73.4%), and had Medicare insurance (54.6%). History of IBD was associated with an increased risk of sepsis (aOR 1.15, P = 0.01), shock (aOR 1.26, P = 0.007), and AKI (aOR 1.25, P < 0.001). There was no difference in mechanical ventilation or in-hospital mortality between patients with IBD and those without. CONCLUSION Among patients hospitalized with COVID-19 infection, those with a history of IBD had an increased risk of sepsis, shock, and AKI. However, IBD did not confer an increased risk of mechanical ventilation or in-hospital mortality. IBD patients who develop COVID-19 infection should be evaluated diligently as their disease state may predispose them to shock and organ injury. Further studies are needed to elucidate why these patients do not have an increased rate of ventilator-dependent respiratory failure or death. Inclusion process for the study.