Risk Factors of Cytomegalovirus Reactivation in Ulcerative Colitis Patients: A Meta-Analysis.

Yafei Qin,Grace Wang,Hongda Wang,Dejun Kong,Guangming Li,Hong Qin,Hao Wang

doi:10.3390/diagnostics11111952

Abstract

Cytomegalovirus (CMV) infection is associated with exacerbation of disease activity in patients with ulcerative colitis (UC). However, the risk factors for CMV reactivation in this population remain debatable. This meta-analysis was performed to identify the risk factors for CMV reactivation in UC patients. PubMed, Cochrane Library, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched from the inception of these databases to 31 August 2021, with the aim of identifying studies that investigated the risk factors of CMV reactivation in UC patients. A quality assessment of the included studies was performed with the Newcastle-Ottawa Scale. The publication bias was assessed respectively via a funnel plot and Egger’s regression asymmetry test. The robustness and reliability of each outcome were evaluated by sensitivity analysis. Twenty studies were included in the final meta-analysis, comprising a total of 2099 patients with UC. A significantly higher risk of CMV reactivation was observed in patients with severe UC (OR = 1.465, 95% CI: 1.107 to 1.939, p = 0.008), pancolitis (OR = 2.108, 95% CI: 1.586 to 2.800, p = 0.0001), older age of UC onset (MD = 6.212, 95% CI: 2.552 to 9.971, p = 0.001), as well as use of glucocorticoids (OR = 4.175, 95% CI: 3.076 to 5.666, p = 0.001), immunosuppressants (OR = 1.795, 95% CI: 1.289 to 2.501, p = 0.001), and azathioprine (OR = 1.444, 95% CI: 1.012 to 2.061, p = 0.043). However, infliximab treatment was observed not to increase the occurrence of CMV reactivation in patients who suffered from UC. In contrast, 5-aminosalicylic acid (OR = 0.674, 95% CI: 0.492 to 0.924, p = 0.014) was associated with a lower risk of CMV reactivation. Patients with UC should be closely monitored for risk factors of CMV reactivation in order to provide timely diagnosis and antiviral treatment.

Highlights

The prevalence of ulcerative colitis (UC) has steadily increased over the last few decades [1], in Europe, Canada, and the United States [2,3]
The articles were included in this meta-analysis as long as they met the criteria of PICOS: (I) Population: Patients with a definitive diagnosis of UC; (II) Intervention: Different disease features and therapeutic options; (III) Comparison: UC patients with or without CMV reactivation
Pooling the results demonstrated that infliximab therapy was not a risk factor for CMV reactivation (OR = 1.915, 95% CI: 0.870 to 4.217, p = 0.107; Figure 10)

Summary

Introduction

The prevalence of ulcerative colitis (UC) has steadily increased over the last few decades [1], in Europe, Canada, and the United States [2,3]. The accumulating literature indicates that human cytomegalovirus (CMV) raises the risk of colectomy and mortality in patients with UC [6]. CMV, which belongs to the Herpesviridae family, is an opportunistic virus with latent and reactivated characteristics [7]. CMV can remain quiescent inside a human host, but CMV replication is further activated in circumstances of immune imbalance [8]. Patients with UC are more susceptible to CMV reactivation due to a compromised intestinal immunological barrier, as well as exposure to numerous immunosuppressive agents [9,10]. The risk of reactivation of CMV has been reported to range from 21% to 34% in patients with severe UC and from 32% to 36%

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