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      Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

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          Abstract

          Objectives

          COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear.

          Design

          This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death).

          Results

          Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death.

          Conclusions

          Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.

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          Most cited references16

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            A pneumonia outbreak associated with a new coronavirus of probable bat origin

            Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.
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              Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

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                Author and article information

                Journal
                Gut
                Gut
                gutjnl
                gut
                Gut
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0017-5749
                1468-3288
                April 2020
                30 April 2020
                : gutjnl-2020-321411
                Affiliations
                [1 ] departmentGastroenterology Unit, Rho Hospital, Rho (MI) , ASST Rhodense , Garbagnate Milanese, Italy
                [2 ] departmentIBD Unit , Don Calabria Sacred Heart Hospital , Negrar, Veneto, Italy
                [3 ] departmentIBD Center, Gastroenterology , Humanitas Clinical and Research Center - IRCCS , Rozzano, Milan, Italy
                [4 ] departmentDepartment of Biomedical Sciences , Humanitas University , Milan, Italy
                [5 ] departmentGastroenterology Unit , ASST Fatebenefratelli Sacco , Milano, Lombardia, Italy
                [6 ] departmentMedicine, Gastroenterology and Digestive Endoscopy Department , Poliambulanza Brescia Hospital , Brescia, Lombardia, Italy
                [7 ] departmentUOC Gastroenterology and Digestive Endoscopy , ASST Bergamo Est , Seriate, Lombardia, Italy
                [8 ] departmentGastroenterology Unit , ASST Spedali Civili di Brescia , Brescia, Lombardia, Italy
                [9 ] departmentDepartment of Surgical, Oncological and Gastroenterological Sciences , University of Padua , Padova, Veneto, Italy
                [10 ] departmentDivision of Digestive Endoscopy and Gastroenterology , Valduce Hospital , Como, Italy
                [11 ] departmentGastroenterology and Endoscopy Unit , La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico , Milano, Lombardia, Italy
                [12 ] departmentDepartment of Pathophysiology and Transplantation , University of Milan , Milano, Lombardia, Italy
                [13 ] departmentFirst Department of Internal Medicine , Università degli Studi di Pavia , Pavia, Lombardia, Italy
                [14 ] departmentGastroenterology Unit , Azienda Ospedaliera San Gerardo , Monza, Lombardia, Italy
                [15 ] departmentGastroenterology Unit , Ospedale Santa Maria di Ca Foncello , Treviso, Veneto, Italy
                [16 ] departmentDivision of Gastroenterology , IRCCS Ospedale Casa Sollievo della Sofferenza , San Giovanni Rotondo, Puglia, Italy
                [17 ] departmentGastroenterology , Federico II University Hospital , Napoli, Campania, Italy
                [18 ] departmentGastroenterology Uniit , ASST dei Sette Laghi , Varese, Lombardia, Italy
                [19 ] departmentDepartment of Medicine and Aging Science , University Gabriele d'Annunzio of Chieti and Pescara , Chieti, Abruzzo, Italy
                [20 ] departmentGastroenterology Unit , Azienda Ospedaliero Universitaria Careggi , Firenze, Toscana, Italy
                [21 ] departmentGastreonterology Unit , ASST Rhodense , Garbagnate Milanese, Lombardia, Italy
                [22 ] departmentGastroenterology Unit , IRCCS Policlinico San Danato , San Donato Milanese, Lombardia, Italy
                [23 ] departmentDivision of Gastroenterology, Department of Medical Sciences , University of Turin , Torino, Piemonte, Italy
                [24 ] departmentInternal Medicine, Gastroenterology Unit, Bufalini Hospital , AUSL della Romagna , Cesena, Italy
                [25 ] departmentGastroenterology Division , Arcispedale S Maria Nuova , Reggio Emilia, Emilia-Romagna, Italy
                [26 ] departmentGastroenterology Unit , ASST Rhodense , Garbagnate Milanese, Lombardia, Italy
                [27 ] departmentUnit of Gastroenterology, Department of Medical Science and Public Health , University of Cagliari , Cagliari, Sardegna, Italy
                [28 ] departmentIBD Unit , Policlinico Universitario Agostino Gemelli , Roma, Lazio, Italy
                [29 ] Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia , Roma, Lazio, Italy
                [30 ] departmentGastroenterology Unit , Azienda Ospedaliera Ordine Mauriziano di Torino , Torino, Piemonte, Italy
                Author notes
                [Correspondence to ] Dr Cristina Bezzio, Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy; cribezzio03@ 123456yahoo.it
                Author information
                http://orcid.org/0000-0003-0076-8549
                http://orcid.org/0000-0001-5677-2534
                http://orcid.org/0000-0002-4397-4142
                http://orcid.org/0000-0002-8077-8175
                http://orcid.org/0000-0002-6654-4911
                http://orcid.org/0000-0002-9421-3087
                http://orcid.org/0000-0003-1573-6451
                http://orcid.org/0000-0001-5623-2968
                Article
                gutjnl-2020-321411
                10.1136/gutjnl-2020-321411
                7242872
                32354990
                f318c3c0-88bb-42c8-befc-add1b0cd8e18
                © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

                This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

                History
                : 14 April 2020
                : 18 April 2020
                : 20 April 2020
                Categories
                Inflammatory Bowel Disease
                2474
                2312
                Original research
                Custom metadata
                free

                Gastroenterology & Hepatology
                ibd,epidemiology
                Gastroenterology & Hepatology
                ibd, epidemiology

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