DOP23 Long-term health consequences of COVID-19 in patients with Inflammatory Bowel Diseases – A Danish prospective population-based cohort study
Attauabi, M.(1,2,3);Dahlerup, J.F.(4);Poulsen, A.(5);Hansen, M.R.(6);Vester-Andersen, M.K.(7);Eraslan, S.(2);Prahm, A.P.(5);Pedersen, N.(8);Larsen, L.(9);Jess, T.(9,10);Neumann, A.(11);Haderslev, K.V.(12);Molazahi, A.(13);Lødrup, A.B.(14);Glerup, H.(15);Oppfeldt, A.M.(16);Jensen, M.D.(17);Theede, K.(1,3);Kiszka-Kanowitz, M.(1,3);Seidelin, J.B.(2);Burisch, J.(1,3);
(1)Copenhagen University Hospital- Hvidovre, Gastrounit- Medical Section, Hvidovre, Denmark;(2)Herlev Hospital- University of Copenhagen, Department of Gastroenterology and Hepatology, Herlev, Denmark;(3)University of Copenhagen- Hvidovre Hospital, Copenhagen Center for Inflammatory Bowel Disease in Children- Adolescents and Adults, Hvidovre, Denmark;(4)Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark;(5)Bispebjerg University Hospital, Digestive Disease Center, Copenhagen, Denmark;(6)North Zealand University Hospital, Department of Gastroenterology, Frederikssund, Denmark;(7)Zealand University Hospital- Koege, Department of Internal Medicine, Koege, Denmark;(8)Slagelse Hospital, Department of Gastroenterology, Slagelse, Denmark;(9)Aalborg University Hospital, Department of Gastroenterology and Hepatology, Aalborg, Denmark;(10)Aalborg University, National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease PREDICT- Department of Clinical Medicine, Copenhagen, Denmark;(11)Region Hospital Viborg, Department of Internal Medicine, Viborg, Denmark;(12)Rigshospitalet- Copenhagen University Hospital, Department of Gastroenterology, Copenhagen, Denmark;(13)Holbaek Hospital, Department of Internal Medicine, Holbaek, Denmark;(14)Region Hospital West Jutland- Herning, Department of Internal Medicine, Herning, Denmark;(15)Region Hospital Silkeborg, Department of Internal Medicine, Silkeborg, Denmark;(16)Region Hospital Horsens, Department of Internal Medicine, Horsens, Denmark;(17)Lillebaelt Hospital, Department of Internal Medicine- Section of Gastroenterology, Vejle, Denmark; Danish COVID-IBD Study Group
Background
The vast majority of patients with ulcerative colitis (UC) and Crohn’s disease (CD) who acquire coronavirus disease 2019 (COVID-19) survive the infection. Still, the long-term health consequences of COVID-19 are not well described in patients with underlying inflammatory bowel disease (IBD).
Methods
We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive population-based database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID-19 was defined as requirement of COVID-19 related hospitalization. Sequelae following COVID-19 were defined as symptoms that developed during or after an infection consistent with COVID-19, were present for more than 12 weeks, and were not attributable to alternative diagnoses.
Results
The study included 319 patients with UC and 197 patients with CD from January 28th, 2020, to April 1st, 2021. Of these, a total of 137 (42.9%) and 85 (43.1%), respectively, participated in a subsequent investigation of post-COVID-19 sequelae after a median of 5.1 months (IQR 4.5-7.9) after infection (Table 1). An equal proportion of patients with UC (58 (42.3%)) and CD (39 (45.9%), p=0.60) reported persisting symptoms of COVID-19 for at least 12 weeks, consistent with the development of post-COVID-19 syndrome. The most common persisting patient-reported symptoms included fatigue (UC: 49 (35.8%), CD: 31 (36.5%), p=0.92), anosmia (UC: 37 (27.0%), CD: 25 (29.4%), p=0.70), ageusia (UC: 26 (19.0%), CD: 24 (28.2%), p=0.11), headache (UC: 19 (13.9%), CD: 16 (18.8%), p=0.32), dyspnea (UC: 19 (13.9%), CD: 16 (18.8%), p=0.32), and arthralgia (UC: 17 (12.4%), CD: 14 (16.5%), p=0.40) (Figure 1). Only discontinuation of immunosuppressive therapies for UC during COVID-19 (OR=1.50 (95% CI 1.07-10.22), p=0.01) and the severity of COVID-19 among patients with CD were independently associated with the long-term effects of COVID-19 (OR=2.76 (95% CI 1.05-3.90), p=0.04) (Tables 2-3).
Conclusion
This Danish population-based study found a high occurrence of patient-reported persisting symptoms following the acute phase of COVID-19 infection, which were associated with the discontinuation of immunosuppressive therapies for UC during COVID-19 and the severity of COVID-19 among patients with CD. These findings might have implications for planning the healthcare of patients with inflammatory bowel diseases in the post-COVID-19 era.