Pancolitis associated with higher mortality risk of cytomegalovirus colitis in patients without inflammatory bowel disease

Figures & data

Table 1 Baseline characteristics of CMV colitis patients without IBD

Characteristics	Result
Case number	61
Age, years	61.2±20.0
Gender (male)	36 (59%)
Hospital stay, day	172.7±639.9
Follow-up duration (day)	116 (3–5,178)
General condition within 1 week
Sepsis	45 (73.8%)
Shock	22 (36.1%)
Respiratory failure	22 (36.1%)
Clinical symptom triggering colonoscopy
Melena	25 (41%)
Diarrhea	27 (44.3%)
Abdominal pain	6 (9.8%)
Positive stool occult blood test	2 (3.3%)
Other (no definite record)	1 (1.6%)
Immunocompromised status	26 (42.6%)
Underlying diseases
Liver cirrhosis	4 (6.6%)
Coronary artery disease	8 (13.1%)
End-stage renal disease	8 (13.1%)
Diabetes mellitus	20 (32.8%)
HIV infection	8 (13.1%)
Immunosuppressive medication
Immunosuppressant	6 (9.8%)
Chemotherapy	1 (1.6%)
Steroid	17 (27.9%)
Laboratory data
Total white blood cell count,/µL	7,800 (800–27,300)
Hemoglobin level, g/dL	10.4±2.1
Platelet count, ×1,000/mm^3	228.0±105.8
ALT, IU/L	25.1±17.3
Bilirubin, mg/dL	0.5 (0.2–7.8)
Albumin, g/dL	2.6 (1.7–4.2)
C-reactive protein, mg/dL	73.8±76.6
Viral markers
CMV pp65 antigenemia (n=31)	21 (67.7%)
CMV PCR positive (n=7)	4 (57.1%)
CMV IgG positive, IgM negative (n=34)	26 (76.5%)
CMV IgG negative, IgM positive (n=34)	0 (0.0%)
CMV IgG positive, IgM positive (n=34)	6 (17.6%)
Ganciclovir or valganciclovir treatment	45 (73.8%)
Treatment duration, day	19 (1–151)
Outcome
Perforation	2 (3.3%)
Surgical resection	6 (9.8%)
Inhospital mortality	18 (29.5%)
Overall survival	37 (60.7%)

Notes: Numerical data with normal distribution are presented as mean ± standard deviation and those with non-normal distribution are presented as medium (range). Categorical data are expressed as absolute number (percentage).

Abbreviations: ALT, alanine transaminase; CMV, cytomegalovirus; HIV, human immunodeficiency virus; IBD, inflammatory bowel disease; PCR, polymerase reaction.

Figure 1 The ulcers of CMV colitis in patients without IBD.

Note: (A) Well-demarcated small ulcer, (B) longitudinal ulcer, (C) semi-lunate ulcer, (D) irregular ulcer, (E) deep ulcer (including punch-out ulcer), (F–H) ulcer coated with white membrane, and (I) segmental mucosal defect.
Abbreviations: CMV, cytomegalovirus; IBD, inflammatory bowel disease.

Figure 2 Endoscopic findings of CMV colitis in patients without IBD, except ulcers.

Note: (A) Colitis with/without erosion, (B) pseudomembrane, (C) tumor/polyp-like, and (D) cobblestone appearance.
Abbreviations: CMV, cytomegalovirus; IBD, inflammatory bowel disease.

Table 2 Endoscopic findings of CMV colitis patients without IBD

Characteristics	Result, n (%)
Diagnostic tools
Colonoscopy	31 (50.8)
Sigmoidoscopy	30 (49.2)
Involved area
Rectum (n=61)	35 (57.4)
Sigmoid colon (n=60)	26 (43.3)
Descending colon (n=48)	13 (27.1)
Transverse colon (n=39)	19 (48.7)
Ascending colon (n=34)	18 (52.9)
Cecum (n=31)	13 (41.9)
Ileocecal valve (n=18)	4 (22.2)
Endoscopic finding
Colitis with/without erosion, only	6 (9.8)
Ulcer	47 (77)
Well-demarcated small ulcer	27 (57.5)
Longitudinal ulcer	5 (10.6)
Semi-lunate ulcer	21 (44.7)
Irregular ulcer	12 (25.5)
Deep ulcer (including punch-out ulcer)	11 (23.4)
Ulcer coating with white membrane	7 (14.9)
Segmental mucosal defect	14 (29.8)
Pseudomembrane	6 (9.8)
Tumor/polyp-like	5 (8.2)
Cobblestone appearance	12 (19.7)
Skip lesions	18 (29.5)
Stricture during follow-up	2 (3.3)

Abbreviations: CMV, cytomegalovirus; IBD, inflammatory bowel disease.

Figure 3 Survival curves of CMV colitis patients with/without pancolitis.

Note: The patients of CMV colitis with pancolitis (solid line) had worse overall survival than the ones without pancolitis (dashed line) with log rank p=0.018 according to Kaplan–Meier survival curve analysis.
Abbreviation: CMV, cytomegalovirus.

Table 3 Clinical factors associated with inhospital mortality of CMV colitis patients without IBD (31 patients with full-length colonoscopy)

Characteristics	Odd ratio	95% confidence interval	p-value
Age	1.036	0.993–1.081	0.104
Gender (male/female)	0.188	0.035–1.000	0.050
Immunological status	0.286	0.056–1.466	0.133
Underlying diseases
Liver cirrhosis	0.000	0.000	1.000
End-stage renal disease	5.923×10^9	0–>10^12	0.999
Diabetes mellitus	3.600	0.655–19.78	0.141
HIV infection	0.000	0.000	0.999
Immunosuppressive medication
Immunosuppressant	2.625	0.146–47.183	0.513
Chemotherapy	4.443	0–>10^12	1.000
Steroid	0.500	0.083–3.011	0.449
Laboratory data
Total white blood cell count,/µL	1.000	1.000	0.934
Hemoglobin level, g/dL	0.690	0.436–1.091	0.112
Platelet count, ×1,000/mm^3	0.993	0.984–1.003	0.164
ALT, IU/L	0.957	0.886–1.034	0.267
Bilirubin, mg/dL	1.508	0.827–2.750	0.180
Albumin, g/dL	0.308	0.055–1.736	0.182
C-reactive protein, mg/dL	1.009	0.997–1.022	0.146
Involved area
Right-sided colitis (n=12, 35.3%)	0.343	0.058–2.036	0.239
Left-sided colitis (n=8, 23.5%)	0.268	0.028–2.578	0.254
Pancolitis (n=11, 32.4%)	6.800	1.233–37.497	0.028*
Endoscopic finding
Colitis with/without erosion, only
Ulcer	2.353	0.235–23.601	0.467
Well-demarcated small ulcer	0.863	0.254–2.932	0.813
Longitudinal ulcer	1.667	0.254–10.931	0.594
Semi-lunate ulcer	2.051	0.647–6.501	0.222
Irregular ulcer	1.978	0.533–7.340	0.308
Deep ulcer (including punch-out ulcer)	1.469	0.372–5.811	0.583
Ulcer coating with white membrane	3.810	0.757–19.172	0.105
Segmental mucosal defect	0.943	0.253–3.520	0.930
Pseudomembrane	4.443×10^9	0–>10^12	1.000
Tumor/polyp-like	1.250	0.099–15.796	0.863
Cobblestone appearance	0.563	0.054–5.864	0.630
Skip lesions	1.071	0.206–5.584	0.935
Ganciclovir or valganciclovir treatment	9.693×10^8	0–.10^12	0.999
Treatment duration	0.937	0.830–1.057	0.287

Note:

* p<0.05.

Abbreviations: ALT, alanine transaminase; CMV, cytomegalovirus; HIV, human immunodeficiency virus; IBD, inflammatory bowel disease.