The role of cytomegalovirus colitis on short- and long-term outcomes for patients with ulcerative colitis

Abstract

Background and Aim

Cytomegalovirus (CMV) colitis brings great obstacles for treatment of ulcerative colitis (UC). We aimed to assess the impact of CMV colitis on prognostic outcomes and associated risk factors for UC patients.

Methods

A consecutive 77 inpatients diagnosed as UC were collected retrospectively from January 2012 to December 2015. About 33 patients were defined with CMV colitis by histological tests of colon mucosa. Clinical characteristics and outcomes were compared between patients with CMV colitis or those without. The primary outcomes were UC-related colectomy or the first time of disease relapse after discharge.

Results

33 CMV colitis patients had higher frequency of recent steroid treatment (81.8% vs. 31.8%, p < .001), older age of onset (45.3 ± 13.0 vs. 44.5 ± 15.7 years, p = .028) and more severe colitis (p < .001) characterized by lower hemoglobin (99.0 ± 23.2 vs. 114.6 ± 22.6 g/L, p = .004), albumin (29.7 ± 4.6 vs. 35.4 ± 6.5 g/L, p < .001), immunoglobulin G [8.8 (5.9–10.6) vs. 12.3 (9.3–16.2) g/L, p = .003] and higher C reactive protein [48.5 (21.6–73.8) vs. 9.1 (3.6–35.0) mg/L, p < .001]. The occurrence of UC-related colectomy in patients with CMV colitis was more frequent (48.5% vs 20.5%, p<.01) and CMV colitis was proved to be one of risk factors of colectomy with a hazard ratio of 3.15 (95%CI 1.387–7.171, p = .006), mainly in a short term period. UC-related complications almost occurred within 1 year since CMV colitis diagnosis. And UC patients with CMV colitis always experienced early relapse.

Conclusions

CMV colitis increases the colectomy risk mainly in a short term due to severe inflammatory response, early-onset complications or medication treatment failure. There is also potential correlation between CMV colitis and early relapse. Short-term therapy for UC patients with CMV colitis should be more concerned on controlling systemic inflammation and reducing complications whereas long-term maintenance therapy may not require more aggressive intervention.

Keywords:

• Cytomegalovirus colitis
• ulcerative colitis
• risk factors
• prognosis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this study are available from corresponding author upon reasonable request.

Additional information

Funding

This study was supported by National Natural Science Foundation of China [No. 81570505 and No. 81970495], Health Research & Special Projects Grant of China [No. 201002020 and No. 201502005], Natural Science Foundation of Beijing, China [No. 7202161], and CAMS Innovation Fund for Medical Sciences [No. 2016-I2M-3-001 and No. 2019-I2M-2-007].