Gender-Specific Outcomes and Complications in Patients With Inflammatory Bowel Disease Hospitalized for COVID-19: A National Analysis

Introduction: With both disease-mediated and treatment-derived immunosuppression, gender-specific outcomes in patients with inflammatory bowel disease (IBD) hospitalized for COVID-19 remains unknown. Methods: We performed a retrospective review of the 2020 National Inpatient Sample (NIS) ICD10-CM and PCS codes for patients admitted with a principal diagnosis of COVID-19. Patients were subdivided into those with or without IBD, with gender-based subanalysis. Primary outcomes were in-hospital complications. Secondary outcomes were mortality, length of stay (LOS), and healthcare utilization. Frequencies and demographics were compared between groups. Multivariate regression analysis was performed to adjust for patient and hospital characteristics. Results: We identified a total of 1,060,575 discharges with a principal diagnosis of COVID-19, of which 5,784 were in patients with IBD. Patients with IBD admitted for COVID-19 were more likely to be female (53.5% vs 47.1%, P< 0.01) and White (73.9% vs 50.8%, P< 0.01). Adjusting for patient characteristics on multivariate regression, patients with IBD admitted for COVID-19 had higher odds of developing paralytic ileus (aOR 2.02, P< 0.01), venous thromboembolism (aOR 1.98, P< 0.01), Clostridiodes difficile infection (aOR 2.20, P< 0.01), acute kidney injury (AKI; aOR 1.23, P< 0.01), and need for blood products (aOR 1.35, P< 0.01). Despite lower odds of acute respiratory failure (ARF; aOR 0.79, P< 0.01), higher odds of endotracheal intubation (aOR 1.25, P=0.02) and mechanical ventilation > 96 hours (aOR 1.24, P=0.05) was noted. On gender-based subanalysis, females with IBD had lower odds of ARF (aOR 0.72, P< 0.01), endotracheal intubation (aOR 0.54, P< 0.01) and AKI (aOR 0.61, P< 0.01) than males. For secondary outcomes, no difference in mortality, LOS, hospitalization costs or charges was noted for patients with vs without IBD. Gender-based subanalysis in patients with IBD revealed decreased hospitalization costs (-$4,578 per admission, P=0.02) and a non-significant trend towards lower mortality in females (aOR 0.70, P=0.07). Conclusion: In the current 2020 national analysis of COVID-19 hospitalizations, patients with IBD were not found to have an increased mortality or LOS. However, in-hospital complications were found to be more frequent. Gender-based subanalysis revealed lower complication rates and hospitalization costs in females, but no difference in mortality or LOS. Further studies are needed to evaluate trends from 2021-2022 NIS data when available (Table 1). Table 1. - Adjusted Odds Ratio for In-hospital Complications, Mortality, Length of Stay, and Hospital Utilization in Patients Admitted for a Principal Diagnosis of COVID-19 IBD vs. Non-IBD patients IBD patients - Gender Subanalysis (male gender as reference) Adjusted odds ratio (95% confidence interval) P value Adjusted odds ratio (95% confidence interval) P value In-hospital Complications Acute kidney injury 1.23 (1.06 – 1.44) < 0.01* 0.61 (0.46 – 0.81) < 0.01* Need for hemodialysis 0.88 (0.62 – 1.26) 0.50 0.51 (0.24 – 1.08) 0.08 Blood product transfusion 1.35 (1.06 – 1.73) < 0.01* 0.79 (0.48 – 1.29) 0.35 Venous thromboembolism 1.98 (1.46 – 2.70) < 0.01* 0.70 (0.37 – 1.31) 0.27 Acute respiratory failure 0.79 (0.70 – 0.89) < 0.01* 0.72 (0.57 – 0.92) < 0.01* Endotracheal intubation 1.25 (1.04 – 1.53) 0.02* 0.54 (0.37 – 0.81) < 0.01* Mechanical ventilation ≥96 hours 1.24 (1.02 – 1.58) 0.05* 0.74 (0.46 – 1.20) 0.23 Tracheostomy 1.06 (0.55 – 2.03) 0.85 1.87 (0.43 – 8.15) 0.40 Bacteremia 1.23 (0.71 – 2.14) 0.44 1.19 (0.39 – 3.89) 0.76 Sepsis 1.06 (0.77 – 1.45) 0.69 0.70 (0.39 – 1.26) 0.24 Shock 1.72 (0.92 – 3.20) 0.08 1.35 (0.40 – 4.55) 0.62 Paralytic ileus 2.02 (1.20 – 3.41) < 0.01* 1.74 (0.55 – 5.42) 0.33 Clostridiodes difficile infection 2.20 (1.09 – 4.42) < 0.01* 1.23 (0.33 – 4.62) 0.75 Secondary Outcomes Mortality 1.04 (0.85 – 1.28) 0.65 0.70 (0.48 – 1.03) 0.07 Length of stay (adjusted difference, days) 0.59 (0.08 - 1.10) 0.23 0.26 (0.71 – 1.23) 0.60 Total hospitalization costs (adjusted mean difference, USD) +2,010 (-124 - 4,145) 0.06 -4,578 (-8,633- -524) 0.02* Total hospitalization charges (adjusted mean difference, USD) +5,487 (-2,608 - 13,583) 0.18 -13,550 (-29,357 - 2,256) 0.09 Adjusted odds ratio for in-hospital complications, mortality, length of stay, and healthcare utilization in patients admitted for a principal diagnosis of COVID-19. Comparing patients with and without a history of inflammatory bowel disease (IBD) on multivariate analysis, significant differences were noted on odds of in-hospital complications in patients admitted for coronavirus disease 2019 (COVID-19). Adjusting for patient and hospital characteristics, patients with IBD admitted for COVID-19 were noted to be at increased odds of developing acute kidney injury, venous thromboembolism, paralytic ileus, and Clostridiodes difficile infection. Additionally, increased odds of requiring blood product transfusion was noted. Although lower odds of acute respiratory failure was found, patients with IBD were an increased odds of requiring endotracheal intubation and mechanical ventilation beyond 96 hours. No significant differences were noted on overall mortality, length of stay, hospitalization cost, or hospitalization charges. On gender-based subanalysis, female patients were noted to have significantly lower odds of developing acute kidney injury and acute respiratory failure compared to their male counterparts. Additionally, females were at lower odds of needing endotracheal intubation. In terms of secondary outcomes, a non-significant trend towards lower mortality was noted in females. In terms of healthcare utilization, females were noted to have significantly lower adjusted cost of hospitalization compared to their male counterparts, with the mean adjusted difference being -$4,578 per admission. Although a trend towards lower total hospitalization charges was noted, this did not reach significance. COVID-19: Coronavirus disease 2019, IBD: Inflammatory bowel disease, *: P<0.05.