University of Massachusetts Medical School, Baystate Campus, Springfield, MA, USA.
Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Inflamm Bowel Dis. 2022 Aug 1;28(8):1265-1279. doi: 10.1093/ibd/izab236.
Our understanding of coronavirus disease 2019 (COVID-19) and its implications for patients with inflammatory bowel diseases (IBD) is rapidly evolving. We performed a systematic review and meta-analysis to investigate the epidemiology, clinical characteristics, and outcomes in IBD patients with COVID-19.
We searched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv, and Google Scholar from inception through October 2020. We included studies with IBD patients and confirmed COVID-19. Data were collected on the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalization, intensive care unit (ICU), admission, and death.
Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the prevalence of infection was 1.01% (95% confidence interval [CI], 0.92-1.10). Of IBD patients with COVID-19, 52.7% had Crohn's disease, 42.2% had ulcerative colitis, and 5.1% had indeterminate colitis. Nine studies (n = 687) reported outcomes according to IBD therapy received. Compared with patients on corticosteroids, those on antitumor necrosis factor (anti-TNF) therapy had a lower risk of hospitalization (risk ratio [RR], 0.24; 95% CI, 0.16-0.35; P < .01; I2 = 0%) and ICU admission (RR, 0.10; 95% CI, 0.03-0.37; P < .01) but not death (RR, 0.16; 95% CI, 0.02-1.71; P = .13; I2 = 39%). Compared with patients on mesalamine, those on antitumor necrosis factor therapy had a lower risk of hospitalizations (RR, 0.37; 95% CI, 0.25-0.54), ICU admissions (RR, 0.20; 95% CI, 0.07-0.58), and death (0.21; 95% CI, 0.04-1.00). Comparing patients on immunomodulators vs mesalamine or anti-TNF therapy, there was no difference in these outcomes.
The prevalence of COVID-19 in IBD patients was low. Use of corticosteroids or mesalamine was significantly associated with worse outcomes, whereas use of anti-TNFs was associated with more favorable outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.
我们对 2019 年冠状病毒病（COVID-19）及其对炎症性肠病（IBD）患者的影响的理解正在迅速发展。我们进行了系统评价和荟萃分析，以调查 IBD 合并 COVID-19 患者的流行病学、临床特征和结局。
我们检索了 PubMed、EMBASE、Cochrane 中心、Clinicaltrials.gov、Web of Science、MedRxiv 和 Google Scholar，检索时间为从建库到 2020 年 10 月。我们纳入了有 IBD 患者且确诊 COVID-19 的研究。收集的数据包括 IBD 患者的患病率、患者特征、IBD 的预感染治疗、合并症、住院、重症监护病房（ICU）、入住和死亡。
纳入了 23 项研究，共计 51643 例 IBD 患者和 1449 例 COVID-19 患者。在纳入了 IBD 患者合并和不合并 COVID-19 的 14 项研究（n=50706）中，感染率为 1.01%（95%置信区间[CI]，0.92-1.10）。在有 COVID-19 的 IBD 患者中，52.7%患有克罗恩病，42.2%患有溃疡性结肠炎，5.1%患有未定型结肠炎。9 项研究（n=687）报告了根据 IBD 治疗方案所获得的结局。与接受皮质类固醇治疗的患者相比，接受肿瘤坏死因子（anti-TNF）治疗的患者住院（风险比[RR]，0.24；95%CI，0.16-0.35；P<.01；I2=0%）和入住 ICU（RR，0.10；95%CI，0.03-0.37；P<.01）的风险较低，但死亡（RR，0.16；95%CI，0.02-1.71；P=0.13；I2=39%）的风险没有差异。与接受美沙拉嗪治疗的患者相比，接受 anti-TNF 治疗的患者住院（RR，0.37；95%CI，0.25-0.54）、入住 ICU（RR，0.20；95%CI，0.07-0.58）和死亡（0.21；95%CI，0.04-1.00）的风险较低。比较接受免疫调节剂与美沙拉嗪或 anti-TNF 治疗的患者，这些结局没有差异。
IBD 患者 COVID-19 的患病率较低。使用皮质类固醇或美沙拉嗪与更差的结局显著相关，而使用 anti-TNF 与更有利的结局相关。进一步的研究阐明这些不同观察结果的机制，可以帮助确定 IBD 患者的风险和不良结局缓解策略。
