P-030 Treatment for CMV Infection in UC Patients Significantly Decreased the Colectomy Rate

Abstract

The incidence of CMV colitis in steroid refractory IBD has been reported to range from 15.8 to 34%. Current available literatures are limited to small scale studies and showed conflicting result regarding the role of CMV in IBD exacerbation, whether CMV is an innocent by-stander, a contributing factor or a surrogate marker of severe disease. We performed this historical cohort study in the largest IBD population with CMV infection from CCF pathology database to investigate the role of CMV treatment on the clinical outcomes of CMV infected UC patients. Our aim is to compare the clinical outcomes of CMV positive UC patients between treated group and non-treated group. Total of 40 UC patients who had positive immunohistochemistry for CMV on colon biopsy from 1990 to 2013 were recruited from pathology database at CCF. 17 demographic data were collected. 4 clinical outcomes (requirement of hospitalization, requirement for colectomy within 30 days and 12 months, re-hospitalization, and mortality within 12 months) were compared between CMV treated and non-treated patients. In addition, we also looked at the role of CMV blood DNA on the clinical outcomes in UC patients who received the treatment. Among these 40 UC patients, 25 (62.5%) patients had CMV treatment, while 15 (37.5%) did not. All the demographic variables are similar between these 2 groups (Table 1). It appeared that patients who had positive blood CMV PCR (>1000 copies in whole blood) tended to receive anti-viral treatment more often (44% versus 13.3%, P < 0.01). Among the clinical outcomes, patients with CMV treatment tended to have much lower colectomy rate within 30 days (28% versus 66.7%, P < 0.01) and within 1 year (52% versus 73.3%, P < 0.01) compared to untreated group. Other outcomes were comparable in hospitalization, re-hospitalization and mortality (P > 0.05) (Table 2). When the treated UC patients were further sub-grouped based on the presence or absence of CMV blood DNA, no significant difference was observed in any of the clinical outcomes. Our study for the first time looked at the largest CMV infected UC population based on tissue immunohistochemistry stain and found that treatment for CMV decreased the colectomy rate significantly in UC patients within 30 days of infection and also 1 year after. Although the presence of blood CMV DNA appeared to be associated with more frequent treatment, it did not worsen the clinical outcomes. Therefore, it will be critical to initiate the evaluation and treatment for UC population for CMV infection in the future management to improve their outcome.