Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey
Natália Sousa Freitas Queiroz, Fábio Vieira Teixeira, Marina Pamponet Motta, Liliana Andrade Chebli, Adriano Akira Ferreira Hino, Camilla de Almeida Martins, Abel Botelho Quaresma, Alexandre Augusto de Paula da Silva, Adérson Omar Mourão Cintra Damião, Rogerio Saad-Hossne, Paulo Gustavo Kotze
Natália Sousa Freitas Queiroz, Camilla de Almeida Martins, Adérson Omar Mourão Cintra Damião, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, SP, Brazil
Fábio Vieira Teixeira, IBD Unit, Gastroenterology Department, Gastrosaúde Clinic, Marilia 17509190, SP, Brazil
Marina Pamponet Motta, School of Medicine, Federal University of Bahia, Salvador 40020-025, BH, Brazil
Liliana Andrade Chebli, IBD Outpatient Clinics, Universidade Federal de Juiz de Fora, Juiz de Fora 36010-010, MG, Brazil
Adriano Akira Ferreira Hino, Alexandre Augusto de Paula da Silva, Paulo Gustavo Kotze, Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
Abel Botelho Quaresma, Departamento de Ciências da Saúde, Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba 89600-000, SC, Brazil
Rogerio Saad-Hossne, Botucatu Medical School, Paulista State University (UNESP), Botucatu 18600-050, SP, Brazil
Paulo Gustavo Kotze, IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
Author contributions: Kotze PG, Hino AAF and Queiroz NSF designed the study; Motta MP, Martins CA, Kotze PG, Queiroz NSF and Hino AAF participated in the acquisition, analysis and interpretation of the data and wrote the manuscript; Teixeira FV, Motta MP, Chebli LA, Martins CA, Quaresma AB, Silva AAP, Damião AOMC were involved in Grupo de Estudos da Doença Inflamatória Intestinal do Brasil COVID task force and critically reviewed the article for important intellectual content.
Institutional review board statement: The study was approved by the GEDIIB ethical review board under the protocol No. 002/2020 on October 28th, 2020. Informed consent was waived because the survey recruitment was self-selective. In addition, data were de-identified. Individual participant data were not published, which maintained confidentiality in all steps of study analysis. This study was conducted in compliance with regulations stated in the 1975 Declaration of Helsinki.
Informed consent statement: As this is a cross-sectional survey analyzing anonymous data, and information used derived from an unidentified database, informed consent from each individual was waived.
Conflict-of-interest statement: Kotze PG reports grants and personal fees from Takeda, grants and personal fees from Pfizer, personal fees from Janssen, personal fees from Abbvie, personal fees from Novartis, personal fees from Ferring, outside the submitted work.
Data sharing statement: Study data are de-identified. Data are provided only for the approved study. Data will not be shared with anyone outside of the named members of the investigator team.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Paulo Gustavo Kotze, MD, MSc, PhD, Doctor, Professor, Surgeon, IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Rua Bruno Filgueira, 369 cj.1205, Curitiba 80440-220, PR, Brazil. pgkotze@hotmail.com
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: January 23, 2021
Revised: January 28, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: March 28, 2021
BACKGROUND
Coronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications.
AIM
To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil.
METHODS
The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country.
RESULTS
A total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467).
CONCLUSION
This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified.
Core Tip: The coronavirus disease 2019 pandemic is still evolving globally, and Brazil is currently one of the most affected countries. The Brazilian Inflammatory Bowel Diseases Study Group developed a web-based survey of 3568 patients that was adapted from the guidelines of the British Society of Gastroenterology. This study indicates a distinct geographical distribution of patients with inflammatory bowel disease at higher risk for coronavirus disease 2019 complications in different states of the country, which may reflect contrasting socioeconomic, educational and health aspects. No association between high risk and coronavirus disease 2019-related mortality rates has been identified.
