Copyright
©The Author(s) 2021.
World J Gastroenterol. Mar 28, 2021; 27(12): 1226-1239
Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1226
Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1226
Table 1 Recommendations for inflammatory bowel disease patients according to their risk level
| Highest risk |
| Stay home at all times and do not leave, even to buy food, medicine or to do exercises |
| Maintain attendance to infusions (only time to leave home) and the use of prescribed IBD medications |
| Stay at least 2 m (3 steps) from other people, including family members at home, whenever possible |
| Delivered products must be left outside the house by the courier |
| Anyone entering home must wash their hands thoroughly with soap for at least 20 s |
| Do not receive any visitors, unless help is needed |
| Moderate risk |
| Avoid contact with people with symptoms of COVID-19 |
| Avoid using public transportation, crowds, public spaces and meetings with friends or family |
| Home office whenever possible |
| Use smartphones or virtual technology to contact physicians or other essential services |
| Lowest risk |
| All risk groups must follow the recommendations of the World Health Organization |
| Wash hands thoroughly with soap for at least 20 s, frequently |
| Use 70% alcohol gel if soap or water is not available |
| Avoid touching the face |
| Clean objects and surfaces that are frequently touched (such as door handles and phones) |
| Stay home to help prevent the spread of the virus |
| Leave home for very limited purposes: buying food and medication, exercise once a day (running, walking or cycling) alone or with a family member, help a vulnerable person or donate blood |
| Travel for professional purposes only if strictly necessary |
| When leaving home, minimize the time spent away and keep 2 m away from others |
Table 2 Demographic, clinical and treatment characteristics from the whole sample of patients
| Characteristics | n = 3568 (%) |
| Age (yr) | 38.1 ± 12.3 |
| 0-9 | 10 (0.3) |
| 10-19 | 120 (3.4) |
| 20-29 | 769 (21.6) |
| 30-39 | 1214 (34) |
| 40-49 | 848 (23.8) |
| 50-59 | 379 (10.6) |
| 60-69 | 177 (5.0) |
| ≥ 70 | 51 (1.4) |
| Sex | |
| Male | 1238 (34.7) |
| Smoking | 183 (5.1) |
| Clinical risk factors | |
| Hypertension | 402 (11.3) |
| Diabetes | 119 (3.3) |
| Cardiovascular disease | 107 (3.0) |
| Chronic pulmonary disease | 164 (4.6) |
| Recent abdominal surgery for IBD (< 30 d) | 136 (3.8) |
| Overall IBD medications | |
| No medication | 339 (9.5) |
| Oral steroids | 473 (13.3) |
| 5-ASA | 1221 (34.2) |
| AZA/6-MP/MTX | 1169 (32.8) |
| Biologics | 1832 (51.3) |
| Therapeutic regimen | |
| Oral steroids monotherapy1 | 83 (2.3) |
| 5-ASA monotherapy1 | 758 (21.2) |
| 5-ASA + oral steroids2 | 115 (15.2) |
| AZA/6-MP/MTX monotherapy1 | 556 (15.6) |
| AZA/6-MP/MTX + oral steroids2 | 90 (16.2) |
| Biologic monotherapy1 | 1219 (34.2) |
| Biologic + oral steroids2 | 100 (8.2) |
| Combo therapy3 | 613 (17.2) |
| Combo therapy3 + oral steroids1 | 85 (13.9) |
| COVID-related complications risk | |
| Highest | 768 (23.4) |
| Moderate | 1965 (55.1) |
| Lowest | 836 (21.5) |
Table 3 Demographic, clinical and treatment characteristics by states in Brazil
| Characteristics | São Paulo | Rio de Janeiro | Minas Gerais | Santa Catarina | Paraná | Bahia | Distrito Federal | Rio Grande do Sul | Espírito Santo | Ceará | Pernambuco | Maranhão | Goiás |
| n = 1057 (%) | n = 336 (%) | n = 329 (%) | n = 278 (%) | n = 277 (%) | n = 217 (%) | n = 190 (%) | n = 183 (%) | n = 144 (%) | n = 107 (%) | n = 74 (%) | n = 57 (%) | n = 49 (%) | |
| Clinical risk factors | |||||||||||||
| Age ≥ 70 yr | 7 (0.7) | 2 (0.6) | 2 (0.6) | 7 (2.5) | 9 (3.2) | 1 (0.5) | 2 (1.1) | - | 8 (5.6) | 5 (4.7) | 2 (2.7) | - | - |
| Hypertension | 133 (12.6) | 43 (12.8) | 34 (10.3) | 27 (9.7) | 31 (11.2) | 29 (13.4) | 19 (10.0) | 11 (6.0) | 13 (9.0) | 14 (13.1) | 6 (8.1) | 2 (3.5) | 4 (8.2) |
| Diabetes | 33 (3.1) | 14 (4.2) | 7 (2.1) | 8 (2.9) | 13 (4.7) | 9 (4.1) | 9 (4.7) | - | 8 (5.6) | 6 (5.6) | 2 (2.7) | - | 3 (6.1) |
| Cardiovascular diseases | 23 (2.2) | 10 (3.0) | 4 (1.2) | 10 (3.6) | 12 (4.3) | 9 (4.1) | 9 (4.7) | 3 (1.6) | 8 (5.6) | 6 (5.6) | 2 (2.7) | 3 (5.3) | 1 (2.0) |
| Liver diseases | 52 (4.9) | 15 (4.5) | 12 (3.6) | 17 (6.1) | 11 (4.0) | 8 (3.7) | 10 (5.3) | 11 (6.0) | 5 (3.5) | 1 (0.9) | 3 (4.1) | 2 (3.5) | 2 (4.1) |
| Abdominal surgery for IBD (< 30 d) | 38 (3.6) | 12 (3.6) | 7 (2.1) | 11 (4.0) | 16 (5.8) | 5 (2.3) | 8 (4.2) | 1 (0.5) | 16 (11.1) | 5 (4.7) | 4 (5.4) | 1 (1.8) | 2 (4.1) |
| Overall IBD medications | |||||||||||||
| No medication | 112 (10.6) | 40 (11.9) | 26 (7.9) | 22 (7.9) | 28 (10.1) | 16 (7.4) | 16 (8.4) | 15 (8.2) | 15 (10.4) | 6 (5.6) | 5 (6.8) | 7 (12.3) | 1 (2.0) |
| Oral steroids | 137 (13.0) | 50 (14.9) | 52 (15.8) | 32 (11.5) | 30 (10.8) | 34 (15.7) | 27 (14.2) | 23 (12.6) | 10 (6.9) | 16 (15.0) | 11 (14.9) | 6 (10.5) | 7 (14.3) |
| 5-ASA | 357 (33.8) | 90 (26.8) | 124 (37.7) | 110 (39.6) | 90 (32.5) | 88 (40.6) | 68 (35.8) | 73 (39.9) | 20 (13.9) | 21 (19.6) | 37 (50.0) | 18 (31.6) | 19 (38.8) |
| AZA/6-MP/MTX | 308 (29.1) | 101 (30.1) | 130 (39.5) | 93 (33.5) | 95 (34.3) | 71 (32.7) | 51 (26.8) | 68 (37.2) | 62 (43.1) | 52 (48.6) | 27 (36.5) | 17 (29.8) | 21 (42.9) |
| Biologics | 575 (54.4) | 164 (48.8) | 156 (47.4) | 145 (52.2) | 153 (55.2) | 95 (43.8) | 93 (48.9) | 87 (47.5) | 92 (63.9) | 64 (59.8) | 28 (37.8) | 29 (50.9) | 29 (59.2) |
| Therapeutic regimen | |||||||||||||
| Oral steroid monotherapy1 | 17 (1.6) | 14 (4.2) | 8 (2.4) | 5 (1.8) | 2 (0.7) | 8 (3.7) | 12 (6.3) | 4 (2.2) | 1 (0.7) | 1 (0.9) | 3 (4.1) | - | - |
| 5-ASA monotherapy1 | 212 (20.1) | 57 (17.0) | 67 (20.4) | 67 (24.1) | 49 (17.7) | 68 (31.3) | 45 (23.7) | 46 (25.1) | 11 (7.6) | 12 (11.2) | 23 (31.1) | 12 (21.1) | 14 (28.6) |
| 5-ASA + oral steroids2 | 39 (18.4) | 4 (7.0) | 9 (13.4) | 12 (17.9) | 5 (10.2) | 11 (16.2) | 5 (11.1) | 6 (13.0) | 1 (9.1) | 1 (8.3) | 1 (4.3) | 2 (16.7) | 6 (42.9) |
| AZA/6-MP/MTX monotherapy1 | 141 (13.3) | 61 (18.2) | 72 (21.9) | 39 (14.0) | 45 (16.2) | 30 (13.8) | 24 (12.6) | 31 (16.9) | 25 (17.4) | 24 (22.4) | 15 (20.3) | 9 (15.8) | 5 (10.2) |
| AZA/6-MP/MTX + oral steroids2 | 28 (19.9) | 12 (19.7) | 11 (15.3) | 2 (5.1) | 10 (22.2) | 6 (20.0) | 3 (12.5) | 2 (6.5) | 2 (8.0) | 6 (25.0) | 2 (13.3) | 2 (22.2) | - |
| Biologic monotherapy1 | 408 (38.6) | 124 (36.9) | 98 (29.8) | 91 (32.7) | 103 (37.2) | 54 (24.9) | 66 (34.7) | 50 (27.3) | 55 (38.2) | 36 (33.6) | 16 (21.6) | 21 (36.8) | 13 (26.5) |
| Biologic + oral steroids2 | 21 (5.1) | 17 (13.7) | 18 (18.4) | 6 (6.6) | 9 (8.7) | 2 (3.7) | 5 (7.6) | 5 (10.0) | 4 (7.3) | 2 (5.6) | 3 (18.8) | 1 (4.8) | 1 (7.7) |
| Combo therapy3 | 167 (15.8) | 40 (11.9) | 58 (17.6) | 54 (19.4) | 50 (18.1) | 41 (18.9) | 27 (14.2) | 37 (20.2) | 37 (25.7) | 28 (26.2) | 12 (16.2) | 8 (14.0) | 16 (32.7) |
| Combo therapy3 + oral steroids2 | 32 (19.2) | 3 (7.5) | 6 (10.3) | 7 (13.0) | 4 (8.0) | 7 (17.1) | 2 (7.4) | 6 (16.2) | 2 (5.4) | 6 (21.4) | 2 (16.7) | 1 (12.5) | - |
| Risk classification | |||||||||||||
| Low | 221 (21.0) | 71 (21.1) | 67 (20.4) | 65 (23.4) | 53 (19.1) | 51 (23.5) | 50 (26.3) | 46 (25.1) | 15 (10.4) | 16 (15.0) | 20 (27.0) | 11 (19.3) | 11 (22.4) |
| Medium | 579 (54.8) | 184 (54.8) | 193 (58.7) | 139 (50.0) | 156 (56.3) | 118 (54.4) | 91 (47.9) | 108 (59.0) | 86 (59.7) | 62 (57.9) | 40 (54.1) | 40 (70.2) | 24 (49.0) |
| High | 256 (24.8) | 81 (24.1) | 69 (21.0) | 74 (26.6) | 68 (24.5) | 48 (22.1) | 49 (25.8) | 29 (15.8) | 43 (29.9) | 29 (27.1) | 14 (18.9) | 6 (10.5) | 14 (28.6) |
Table 4 Demographic, clinical and treatment characteristics by states in Brazil (continuation of Table 3)
| Characteristics | Piauí | Amazonas | Pará | Alagoas | Rio Grande do Norte | Mato Grosso | Paraíba | Acre | Sergipe | Mato Grosso do Sul | Tocantins | Rondônia | Roraima | Amapá |
| n = 41 (%) | n = 38 (%) | n = 32 (%) | n = 31 (%) | n = 25 (%) | n = 22 (%) | n = 18 (%) | n = 16 (%) | n = 13 (%) | n = 12 (%) | n = 7 (%) | n = 6 (%) | n = 6 (%) | n = 3 (%) | |
| Clinical risk factors | ||||||||||||||
| Age ≥ 70 yr | - | - | - | - | - | - | 3 (16.7) | 2 (12.5) | - | 1 (8.3) | - | - | - | - |
| Hypertension | 5 (12.2) | 4 (10.5) | 1 (3.1) | 4 (12.9) | 1 (4.0) | 2 (9.1) | 5 (27.8) | 3 (18.8) | 1 (7.7) | 3 (25.0) | - | 3 (50.0) | 3 (50.0) | 1 (33.3) |
| Diabetes | - | 2 (5.3) | - | 1 (3.2) | - | - | 1 (5.6) | 2 (12.5) | - | 1 (8.3) | - | - | - | - |
| Cardiovascular diseases | 1 (2.4) | - | - | - | 1 (4.0) | 1 (4.5) | - | 1 (6.3) | - | 2 (16.7) | - | - | 1 (16.7) | - |
| Liver diseases | 2 (4.9) | 2 (5.3) | 5 (15.6) | 1 (3.2) | 1 (4.0) | 2 (9.1) | 2 (11.1) | - | - | - | - | - | - | - |
| Abdominal surgery for IBD (< 30 d) | 2 (4.9) | 4 (10.5) | 2 (6.3) | 1 (3.2) | - | - | - | 1 (6.3) | - | - | - | - | - | - |
| Overall IBD medications | ||||||||||||||
| No medication | 5 (12.2) | 5 (13.2) | 5 (15.6) | 1 (3.2) | - | 2 (9.1) | - | 2 (12.5) | 1 (7.7) | 3 (25.0) | 2 (28.6) | 1 (16.7) | 3 (50.0) | - |
| Oral steroids | 8 (19.5) | 7 (18.4) | 6 (18.8) | - | 3 (12.0) | 5 (22.7) | 3 (16.7) | 3 (18.8) | 1 (7.7) | 1 (8.3) | - | 1 (16.7) | - | - |
| 5-ASA | 11 (26.8) | 15 (39.5) | 21 (65.6) | 8 (25.8) | 6 (24.0) | 12 (54.5) | 10 (55.6) | 4 (25.0) | 7 (53.8) | 3 (25.0) | 2 (28.6) | 4 (66.7) | 2 (33.3) | 1 (33.3) |
| AZA/6-MP/MTX | 9 (22.0) | 11 (28.9) | 7 (21.9) | 13 (41.9) | 5 (20.0) | 5 (22.7) | 7 (38.9) | 4 (25.0) | 4 (30.8) | 2 (16.7) | 3 (42.9) | 1 (16.7) | - | 2 (66.7) |
| Biologics | 20 (48.8) | 19 (50.0) | 6 (18.8) | 19 (61.3) | 21 (84.0) | 5 (22.7) | 8 (44.4) | 6 (37.5) | 7 (53.8) | 6 (50.0) | 2 (28.6) | 1 (16.7) | 1 (16.7) | 1 (33.3) |
| Therapeutic regimen | ||||||||||||||
| Oral steroid monotherapy1 | 5 (12.2) | - | 1 (3.1) | - | - | - | - | 2 (12.5) | - | - | - | - | - | - |
| 5-ASA monotherapy1 | 9 (22.0) | 9 (23.7) | 15 (46.9) | 4 (12.9) | 3 (12.0) | 10 (45.5) | 8 (44.4) | 4 (25.0) | 3 (23.1) | 2 (16.7) | 1 (14.3) | 4 (66.7) | 2 (33.3) | 1 (33.3) |
| 5-ASA + oral steroids2 | - | 3 (33.3) | 4 (26.7) | - | - | 4 (40.0) | 1 (12.5) | - | - | - | - | 1 (25.0) | - | - |
| AZA/6-MP/MTX monotherapy1 | 2 (4.9) | 5 (13.2) | 5 (15.6) | 7 (22.6) | 1 (4.0) | 5 (22.7) | 2 (11.1) | 2 (12.5) | 2 (15.4) | 1 (8.3) | 2 (28.6) | - | - | 1 (33.3) |
| AZA/6-MP/MTX + oral steroids2 | - | 1 (20.0) | - | - | - | 1 (20.0) | - | 1 (50.0) | - | 1 (100) | - | - | - | - |
| Biologic monotherapy1 | 13 (31.7) | 13 (34.2) | 4 (12.5) | 13 (41.9) | 17 (68.0) | 5 (22.7) | 3 (16.7) | 4 (25.0) | 5 (38.5) | 5 (41.7) | 1 (14.3) | - | 1 (16.7) | - |
| Biologic + oral steroids2 | 1 (7.7) | 3 (23.1) | - | - | 1 (5.9) | - | - | - | 1 (20.0) | - | - | - | - | - |
| Combo therapy3 | 7 (17.1) | 6 (15.8) | 2 (6.3) | 6 (19.4) | 4 (16.0) | - | 5 (27.8) | 2 (12.5) | 2 (15.4) | 1 (8.3) | 1 (14.3) | 1 (16.7) | - | 1 (33.3) |
| Combo therapy3 + oral steroids2 | 2 (28.6) | - | 1 (50.0) | - | 2 (50.0) | - | 2 (40.0) | - | - | - | - | - | - | - |
| Risk classification | ||||||||||||||
| Low | 10 (24.4) | 7 (18.4) | 13 (40.6) | 4 (12.9) | 3 (12.0) | 9 (40.9) | 6 (33.3) | 4 (25.0) | 4 (30.8) | 3 (25.0) | 2 (28.6) | 3 (50.0) | 2 (33.3) | - |
| Medium | 24 (58.5) | 22 (57.9) | 14 (43.8) | 22 (71.0) | 16 (64.0) | 11 (50.0) | 4 (22.2) | 6 (37.5) | 7 (53.8) | 7 (58.3) | 4 (57.1) | 2 (33.3) | 3 (50.0) | 3 (100) |
| High | 7 (17.1) | 9 (23.7) | 5 (15.6) | 5 (16.1) | 6 (24.0) | 2 (9.1) | 8 (44.4) | 6 (37.5) | 2 (15.4) | 2 (16.7) | 1 (14.3) | 1 (16.7) | 1 (16.7) | - |
- Citation: Queiroz NSF, Teixeira FV, Motta MP, Chebli LA, Hino AAF, Martins CA, Quaresma AB, Silva AAPD, Damião AOMC, Saad-Hossne R, Kotze PG. Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey. World J Gastroenterol 2021; 27(12): 1226-1239
- URL: https://www.wjgnet.com/1007-9327/full/v27/i12/1226.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i12.1226