Impact of COVID-19 Pandemic on the Quality of Life of IBD Patients

A Nomogram Based on Laboratory Data, Inflammatory Bowel Disease Questionnaire and CT Enterography for Activity Evaluation in Crohn's Disease

Background

Accurately assessing the activity of Crohn's disease (CD) is crucial for determining prognosis and guiding treatment strategies for CD patients.

Objective

This study aimed to develop and validate a nomogram for assessing CD activity.

Methods

The semi-automatic segmentation method and PyRadiomics software were employed to segment and extract radiomics features from the spectral CT enterography images of lesions in 107 CD patients. The radiomic score (rad-score) was calculated using the radiomic signature formula. Multivariate logistic regression analysis identified the independent risk factors of erythrocyte sedimentation rate, fecal calprotectin, and Inflammatory Bowel Disease Questionnaire (IBDQ), and a nomogram was constructed in combination with rad-score. The nomogram underwent evaluation and testing in the training set (n = 84) and validation set (n = 23), respectively.

Results

The discrimination performance of the combined (AUC 0.877) was marginally superior to that of IBDQ + clinical (AUC 0.854). However, there was no significant difference in AUC between the two models in the validation set (P = 0.206). IBDQ + clinical outperformed clinical (AUC 0.808), clinical outperformed IBDQ (AUC 0.746), and IBDQ outperformed radiomic signature (AUC 0.688). Significant differences in AUC were observed between the two models (radiomic signature vs clinical, P = 0.026; radiomic signature vs IBDQ + clinical, P = 0.011; radiomic signature vs combined, P = 0.008; in the validation set).

Conclusion

The nomogram, combined with laboratory data, IBDQ and rad-score, presents an accurate and reliable method for assessing CD activity.

Clinical Impact

The nomogram enhances the potential for personalized treatment plans and better disease management, making it a valuable tool for clinical practice.

Quality of Life of Pediatric Patients with Chronic Intestinal, Liver, and Pancreatic Diseases During the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

Children with chronic diseases and their families face significant challenges to their quality of life compared to the rest of the population, and the COVID-19 pandemic has been a greater challenge for them. Our research aimed to identify key factors affecting their quality of life.

METHODS

We conducted a cross-sectional study in the Department of Pediatrics of the "Grigore Alexandrescu" Emergency Children's Hospital in Bucharest on a group of 47 pediatric patients aged 9 years or older, diagnosed with chronic liver, gastrointestinal, and pancreatic diseases.

RESULTS

Children reported that their quality of life was not significantly affected by the pandemic due to the inability to see their family members and friends (89.36%), online education (67.5%), and social distancing (50%). Results showed that parents' perceptions of the COVID-19 pandemic had a significant negative correlation with their quality of life (r = -0.35, p < 0.01); also, parents' perceptions of the quality of life had a high negative significant correlation with their children's mental well-being (r = -0.67, p < 0.001). Interestingly, children's mental well-being did not have a significant correlation with their perceptions of quality of life (r = -0.02, p > 0.05). In the context of the COVID-19 pandemic, parents were concerned about their family well-being. Parents with higher scores for the perception of COVID-19's impact tended to have lower scores for health-related quality of life. Also, the parents' quality of life accounted for 44% of the variance in their children's mental well-being.

CONCLUSIONS

Even if the medical issue of the COVID-19 pandemic was not a concern for either children or their parents, many families were anxious about the perceived lack of dependability of the medical system. Addressability was delayed in many cases because of this, and regular medical care is essential for patients with chronic diseases.

The impact of the COVID-19 surge after the end of China's Zero-COVID policy on the health-related quality of life of IBD patients

INTRODUCTION

In December 2019, COVID-19 emerged in Wuhan, Hubei Province, China, and rapidly spread worldwide. On December 2022, the Chinese government ended the zero-COVID policy, leading to a surge in cases and significantly impacting daily life. IBD patients face heightened infection risks and substantial effects on their quality of life during the pandemic.

METHODS

This cross-sectional study collected demographic, COVID-19-related, and HRQoL data from 224 IBD patients who had previously received treatment at Nanjing BenQ Medical Center. Participants completed an online survey between January 9, 2023, and January 23, 2023. The SIBDQ was used to assess HRQoL. Statistical analysis was performed using SPSS version 26.

RESULTS

The study found that UC patients reported higher HRQoL compared to CD patients (p = 0.037). Patients who perceived themselves as less susceptible to COVID-19 had higher scores (p = 0.006 and p = 0.009). Those whose work or study was unaffected also had higher scores (p < 0.001 and p = 0.002). Additionally, irregular medication adherence was associated with lower HRQoL scores (p = 0.014 and p = 0.007). Multivariate linear regression results showed that IBD patients whose work or study was affected during the COVID-19 pandemic scored lower than those who were not affected (p = 0.038; 95% CI, -7.96 to -0.25). Patients who discontinued IBD medication scored higher than those with irregular medication use (p = 0.020; 95% CI, 1.00 to 10.90).

CONCLUSIONS

This study highlights the significant impact of the COVID-19 pandemic on the HRQoL of IBD patients. The findings emphasize the need for integrated care addressing both the physical and psychological aspects of IBD.

Laboratory Data and IBDQ-Effective Predictors for the Non-Invasive Machine-Learning-Based Prediction of Endoscopic Activity in Ulcerative Colitis

A suitable, non-invasive biomarker for assessing endoscopic disease activity (EDA) in ulcerative colitis (UC) has yet to be identified. Our study aimed to develop a cost-effective and non-invasive machine learning (ML) method that utilizes the cost-free Inflammatory Bowel Disease Questionnaire (IBDQ) score and low-cost biological predictors to estimate EDA. Four random forest (RF) and four multilayer perceptron (MLP) classifiers were proposed. The results show that the inclusion of IBDQ in the list of predictors that were fed to the models improved accuracy and the AUC for both the RF and the MLP algorithms. Moreover, the RF technique performed noticeably better than the MLP method on unseen data (the independent patient cohort). This is the first study to propose the use of IBDQ as a predictor in an ML model to estimate UC EDA. The deployment of this ML model can furnish doctors and patients with valuable insights into EDA, a highly beneficial resource for individuals with UC who need long-term treatment.

Has the COVID-19 Pandemic Worsened Health-Related Quality of Life of Patients with Inflammatory Bowel Disease? A Longitudinal Disease Activity-Controlled Study

The present longitudinal study aimed to investigate the burden of disease activity change on health-related quality of life (HRQoL) of patients with inflammatory bowel disease (IBD) during the two different pandemic waves in 2020 and 2021. A sample of 221 IBD patients (recruited during March-May 2020 for T0 and March-May 2021 for T1) was included. The psychological impact of the COVID-19 pandemic (Impact of Event Scale-Revised (IES-R)) and HRQoL (Inflammatory Bowel Disease Questionnaire (IBDQ)) were assessed. Post-traumatic COVID-19-related symptoms (IES-R) were not significantly different across the disease activity-related groups. Conversely, IBDQ was consistently higher in patients with persistent, quiescent disease activity compared to the other groups, as expected. Even after controlling for baseline IES-R, repeated-measures ANCOVA showed a non-significant main effect of time (p = 0.60) but a significant time-per-group interaction effect with a moderate effect size (η2 = 0.08). During the two different phases of pandemic restrictions, IBD-specific HRQoL was modified by disease-related factors such as disease activity, rather than by the post-traumatic symptoms of COVID-19. This lends further weight to the need for developing an evidence-based, integrated, biopsychosocial model of care for patients with IBD to identify subjective and objective factors that affect the burden of disease.

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0-16.7%) needed hospitalization, 0.6% (0-1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients' symptoms, with 21% (0-25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low; therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients.