Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients

Amanda Ricciuto, Christopher A. Lamb, Eric I. Benchimol, Gareth J. Walker, Nicholas A. Kennedy, M. Ellen Kuenzig, Gilaad G. Kaplan, Michael D. Kappelman, Ryan C. Ungaro, Jean Frederic Colombel, Erica J. Brenner, Manasi Agrawal, Walter Reinisch, Anne M. Griffiths, Shaji Sebastian

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background and Aims: Age is a major prognostic factor for COVID-19 outcomes. The effect of inflammatory bowel disease [IBD] activity on COVID-19 is unclear. We examined the relationship between IBD activity and COVID-19 severity according to age. Methods: We included IBD patients diagnosed with COVID-19, reported to SECURE-IBD between March 13, 2020 and August 3, 2021. Clinical IBD activity was measured by physician global assessment [PGA]. COVID-19-related outcomes were [1] intensive care unit [ICU] admission, ventilation or death, and [2] hospitalization. Using generalized estimating equations, we determined adjusted odds ratios [aOR, 95% confidence interval] for moderate and severe PGA vs clinical remission/mild PGA, controlling for demographics, medications and COVID-19 diagnosis period. We performed stratified analyses by age [≤50 vs >50 years]. Results: Among 6078 patients, adverse COVID-19 outcomes were more common with active IBD: ICU/ventilation/death in 3.6% [175/4898] of remission/mild, 4.9% [45/920] of moderate and 8.8% [23/260] of severe [p < 0.001]; and hospitalization in 13% [649/4898] of remission/mild, 19% [178/920] of moderate and 38% [100/260] of severe [p < 0.001]. Stratified by decade, effect sizes were larger for younger patients. In patients ≤50 years, severe PGA was independently associated with ICU/ventilation/death (aOR 3.27 [1.15-9.30]) and hospitalization (aOR 4.62 [2.83-7.55]). In contrast, severe PGA was not independently associated with COVID-19 outcomes in those older than 50 years. Conclusions: Clinically active IBD may be a risk factor for severe COVID-19, particularly in younger patients. IBD disease control, including through medication compliance, and strategies to mitigate the risk of COVID-19 infection amongst patients with active IBD [e.g. distancing, immunization] are key to limit adverse COVID-19 outcomes.

Original languageEnglish
Pages (from-to)591-600
Number of pages10
JournalJournal of Crohn's and Colitis
Issue number4
StatePublished - 1 Apr 2022


  • COVID-19
  • disease activity
  • inflammatory bowel disease


Dive into the research topics of 'Inflammatory Bowel Disease Clinical Activity is Associated with COVID-19 Severity Especially in Younger Patients'. Together they form a unique fingerprint.

Cite this