Cytomegalovirus Infection in IBD: Single Center Experience

Abstract

Introduction: In patients with Inflammatory Bowel Diseases (IBD) there is an increased risk of Cytomegolovirus (CMV) infection possibly due to malnutrition and immunosuppressive medication. There are other risk factors such as advanced age and disease duration more than 5 years. Moreover, there is evidence that CMV infection increases colectomy rates. Anti-viral treatment in CMV infection in IBD patients is controversial. In this study, we aimed to define the CMV infection effect on IBD course. Methods: Patients with IBD who had positive serum CMV-DNA (> 42 copies/ml) between 2013 and 2016 were identified in Ankara University IBD cohort. Patient charts were reviewed retrospectively. We identified 75 patients with positive serum CMV-DNA. Patient demographics, colectomy rates, medication types, mortality rates were abstracted from database retrospectively. Results: Out of 78 patients, 66 patients had Ulcerative Colitis (UC) (88%). Mean age of patients was 39.4 years. 54 % of UC patients had either extensive disease or pancolitis. There was no correlation between age, gender, leucocyte count, crp levels, hemoglobin levels and either mortality or colectomy. CMV viremia did not lead to colectomy. However, in patients who had clinical events (colectomy or mortality), median serum CMV-DNA level was 1038 copies/ml whereas in patients who had spontaneous remission, median serum CMV-DNA level was 182 copies/ml (p value: 0.006). There were higher mortality and colectomy rates in patients with serum CMV DNA levels > 1000 copies/ml (p value: 0.032). Trombosis was found to be an independent risk factor for mortality and colectomy (%95 CI: 19.3 (1.9-188);P:0.011). Steroid use was found to be in 82% of the patients. There was no correlation between steroid use and mortality or colectomy rates. Conclusion: Serum CMV-DNA levels more than 1000 copies/ml increases the colectomy rates in IBD patients. Steroid use seems not to be a factor increases colectomy rate in this cohort. Thrombosis is an independent risk factor for colectomy and mortality in IBD patients with CMV infection.