Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry
Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry
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DOI：
10.1053/j.gastro.2020.05.032
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发表时间：
2020-08-01
期刊：
影响因子：
29.4
通讯作者：
Kappelman, Michael D.
中科院分区：
文献类型：
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作者：
Brenner, Erica J.;Ungaro, Ryan C.;Kappelman, Michael D.
背景和目的：2019冠状病毒病（COVID-19）对炎症性肠病（IBD）患者的影响尚不清楚。我们试图描述IBD患者中COVID-19的临床病程，并评估人口统计学、临床特征和免疫抑制剂治疗对COVID-19结局的相关性。方法：采用正交设计法炎症性肠病排除研究中冠状病毒的监测流行病学（SECUREIBD）是一项大型国际登记研究，旨在监测确诊COVID-19的IBD患者的结局。我们计算了年龄标准化死亡率，并使用多变量逻辑回归来确定与严重COVID-19相关的因素，定义为重症监护病房入院、呼吸机使用和/或死亡。结果：报告了来自33个国家的525例病例（中位年龄43岁，53%为男性）。37名患者（7%）患有严重的COVID-19，161名（31%）住院，16名患者死亡（3%的病死率）。相对于中国、意大利和美国的数据，IBD患者的标准化死亡率比分别为1.8（95%置信区间[CI]，0.9-2.6）、1.5（95% CI，0.7-2.2）和1.7（95% CI，0.9-2.5）。IBD患者中严重COVID-19的风险因素包括年龄增加（校正比值比[a0 R]，1.04; 95% CI，1.011.02），>= 2种合并症（aOR，2.9; 95% CI，1.1-7.8），全身性皮质类固醇（aOR，6.9; 95%CI，2.3-20.5），柳氮磺胺吡啶或5-氨基水杨酸盐使用（aOR，3.1; 95%CI，1.3-7.7）。肿瘤坏死因子拮抗剂治疗与重度COVID-19无关（aOR，0.9; 95%CI，0.4-2.2）。结论：年龄增加、合并症和皮质类固醇与IBD患者中的重度COVID-19相关，尽管因果关系无法明确确定。值得注意的是，肿瘤坏死因子拮抗剂似乎与严重的COVID-19无关。
BACKGROUND AND AIMS: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. METHODS: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECUREIBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. RESULTS: 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [a0R], 1.04; 95% CI, 1.011.02), >= 2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2). CONCLUSIONS: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.