Effect of CMV on Outcomes Among Hospitalized Patients With Crohnʼs Disease

Abstract

Introduction: Cytomegalovirus (CMV) is an opportunistic infection that can affect patients with severe Crohn's disease. Few studies have identified CMV as a risk factor for increased mortality and morbidity in Crohn's disease, but there are limited large database studies to understand the prevalence and affect of CMV in patients with Crohn's disease. We analyzed the national inpatient database (NIS) to understand the impact of CMV among hospitalized patients with Crohn's disease. Methods: We used the 2008-2012 NIS to identify patients aged ≥18 years with the diagnosis of Crohn's disease (international classification of diseases 9th revision, clinical modification [ICD-9-CM] diagnosis code 555.0-555.9) who were admitted to the hospital. Patients with concomitant CMV infection were identified using the ICD-9-CM diagnosis code 078.5. Multivariable regression analyses were used to determine the effect of CMV on outcomes including risk of clostridium difficile infection (CDI), colectomy, hospital length of stay (LOS), and in-hospital death. Results: A total of 932,048 patients were admitted to the hospital with either a primary or secondary diagnosis of Crohn's disease. Majority of the patients (75.4%) were aged 18-65 years, 59.5% of the patients were females, 70.8% of the patients were whites, and 41% of the patients had private insurance as their primary expected payer. Thirty two percent of patients had Crohn's disease as their primary diagnosis. A total of 964 patients (0.1%) had a concomitant diagnosis of CMV. In multivariable analyses, the presence of CMV infection showed a trend towards increased risk of CDI (odds ratio [OR] 2.1, 0.94-4.7, p=0.07), and was significantly associated with increased risk of colectomy (OR 7.6, 3.5-16.4, p <0.001), hospital LOS (OR 9.5, 7.1-12.0, p<0.001), and in-hospital death (OR 5.1, 2.6-9.8, p <0.001). In a secondary analysis only patients with primary diagnosis of Crohn's disease were included and the presence of CMV remained significantly associated with higher risk of CDI, colectomy, LOS and in-hospital death after adjusting for other confounding variables. Conclusion: Around 0.1% of the hospitalized patients with Crohn's disease are affected with CMV. Presence of CMV infection is associated with higher rates of CDI, colectomy, hospital LOS and in-hospital death. Risk adjustment is necessary while evaluating patients with Crohn's disease with concomitant CMV infection.