key: cord-0703985-0z5drora
authors: Gubatan, John; Levitte, Steven; Balabanis, Tatiana; Patel, Akshar; Sharma, Arpita; Habtezion, Aida
title: SARS-CoV-2 Testing, Prevalence, and Predictors of COVID-19 in Patients with Inflammatory Bowel Disease in Northern California
date: 2020-05-07
journal: Gastroenterology
DOI: 10.1053/j.gastro.2020.05.009
sha: 5ab9c420d5335335192220130ddc12490fb7ee93
doc_id: 703985
cord_uid: 0z5drora

nan

Coronavirus disease 2019 , caused by the novel betacoronavirus SARS-CoV-2, is an unprecedented global pandemic [1] . Susceptibility to COVID-19 is a concern among patients with inflammatory bowel disease (IBD) who are at increased risk of infection due to immunosuppressive therapy. The receptor angiotensin converting enzyme 2 (ACE2), which mediates SARS-CoV-2 entry into cells, is upregulated in IBD [2] and may therefore increase host susceptibility. International cohorts have reported no increased risk of COVID-19 in patients with IBD [3, 4] . However, these studies do not report the prevalence of SARS-CoV-2 testing and COVID-19 in IBD patients. Our institution was among the first to initiate large-scale SARS-CoV-2 RNA testing in northern California. We characterized the prevalence and clinical predictors of COVID-19 in patients with IBD.

We performed a retrospective analysis of consecutive patients whose SARS-CoV-2 testing was performed at Stanford between March 04, 2020, and April 14, 2020. California counties tested, institutional testing eligibility, and performance are described in our supplementary methods. Our study was approved by the Stanford Institutional Review Board (Protocol 55975). We included all patients with a diagnosis of Crohn's disease (K50.xx), ulcerative colitis (K51.xx), and indeterminate colitis (K52.3) who underwent testing. We collected data including demographics, IBD characteristics (subtype, location, phenotype, disease activity), co-morbid conditions, reasons for testing, symptoms, medications, and outcomes. We calculated prevalence of IBD among all patients tested and the prevalence of COVID-19 among IBD patients. We performed univariate and multivariate logistic regression using the firthlogit method to determine predictors of COVID-19 in IBD patients. [ suggestive of COVID-19, 3.6% were asymptomatic but had a positive travel history, and 4.8%

were asymptomatic but had direct exposure to a COVID-19 patient. Common presenting symptoms included cough (63.1%), sore throat (41.1%), dyspnea (37.5%), fever (35.7%), and body pain (32.1%). Gastrointestinal symptoms were present in 19.1% of IBD patients, where diarrhea (15.5%), abdominal pain (13.1%), and nausea and vomiting (8.9%) were most common.

Among 168 IBD patients tested, the prevalence of COVID-19 was 3.0% (5/168 

To our knowledge, this is the first study to evaluate the prevalence of SARS-CoV-2 testing and COVID-19 in IBD patients in a U.S. cohort. The prevalence of IBD among patients undergoing SARS-CoV-2 testing is 1.2% which is comparable to the prevalence of IBD (1.3%) in the U.S. adult population [6] . Our COVID-19 positivity rate of 3% in IBD patients is comparable to the population-weighted prevalence of SARS-CoV-2 positive serology in Santa Clara county at 2.8%. [7] Our data suggest that IBD patients are not disproportionately being tested more, nor do they have a higher rate of SARS-CoV-2 positivity compared to the background population in northern California. One explanation is that increased ACE2 expression may not mediate SARS-CoV-2 susceptibility in IBD patients. Another possibility is that immunosuppressive medications in IBD patients may attenuate viral-induced respiratory inflammation leading to an asymptomatic or mild COVID-19 course in IBD patients who subsequently do not seek testing. Our study also demonstrates that patients older than 66 years of age are at increased risk of COVID-19. Our results are consistent with a prior retrospective study from China which demonstrated that older age is an independent predictor of COVID-19 [8] .

The exact mechanisms underlying susceptibility to COVID-19 in elderly patients are unclear and warrant further investigation.

Our study has several strengths. First, our study provides novel epidemiological data that can inform IBD patients and clinicians. Currently, there are no published reports estimating the prevalence of COVID-19 among IBD patients in the U.S. Second, we identified predictors of COVID-19 among IBD patients, highlighting the increased susceptibility of COVID-19 with older age. Third, our study included patients from a large geographic area encompassing a diverse patient population. Our study has several limitations. First, our study was observational and cannot establish causation or account for unmeasured confounders. Second, we were unable to assess the predictors of COVID-19 morbidity and mortality with our small sample size and low event rate. A significantly larger sample size is needed to further clarify predictors of COVID-19 outcomes. Third, our study reflects testing performed by a single center and may not be generalizable to other institutions.

In summary, our results provide much needed epidemiological data and reassurance that COVID-19 rates in IBD patients may be comparable to the general population. Age greater than 66 years old was a strong independent predictor of COVID-19 among patients with IBD. 

Data And Statistics