High mucosal cytomegalovirus DNA helps predict adverse short-term outcome in acute severe ulcerative colitis

Journal article

Background/Aims: Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.Methods: Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.Results: Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.Conclusions: High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC.

Authors: Jain, S; Namdeo, D; Sahu, P; Kedia, S; Sahni, P

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Korean Association for the Study of Intestinal Diseases
• Journal: Intestinal Research
• Volume: 19
• Issue: 4
• Pages: 438-447
• Publication date: 2020-11-05
• DOI: 10.5217/ir.2020.00055
• EISSN: 2288-1956
• ISSN: 1598-9100
• Language: English
• Keywords: Gastroenterology; Term (time); Disease; Ulcerative colitis; Cytomegalovirus; Outcome (game theory); Medicine; Internal medicine; Herpesviridae; Virus; Immunology; Viral disease; Adverse effect