The Incidence of Cytomegalovirus in Acute Severe Colitis in Hospitalized Patients With Inflammatory Bowel Disease in a Community-Based, Safety Net Hospital

Abstract

Introduction: An association between cytomegalovirus (CMV) and acute severe inflammatory bowel disease (IBD) colitis has been demonstrated in prior studies. However, it is unclear whether this association indicates CMV as a causative pathogen in triggering severe flares. This study aimed to assess the incidence of CMV in IBD patients admitted to a community-based, safety-net hospital for acute severe colitis and evaluate risk factors for CMV colitis.2823_A Figure 1. Association between CMV and IBD flares2823_B Figure 2. Risk factors associated with CMV colitisMethods: A retrospective case control study involving all IBD patients admitted from 2013-2017 to a county hospital with acute severe colitis. Data was collected from the hospital's electronic medical record. Data extracted included demographics, IBD type, symptoms on admission, and types of medications used including steroids or biologic therapy. We calculated odds ratios (OR) and confidence intervals for multiple risk factors. Results: Among 45 IBD patients, there were 80 hospitalizations for acute severe colitis. CMV infection was detected in 3 out of 80 (4%) admissions. 67% and 33% of CMV cases had received prior treatment with high dose steroids & biologics respectively, compared to 33% & 29% of cases without CMV infection (OR 4.16, p-value 0.25; OR 1.25, p-value 0.86). Of patients with CMV infection, 67% had ulcerative colitis (UC), 33% Crohn's Disease (CD), 100% were age < 40, 33% were male & 67% female, none had cancer or HIV, and 33% had cytopenia. Of patients without CMV infection, 71% had UC, 29% had CD, 52% were age < 40, 58% were male & 42% female, 1% had cancer, 1% had HIV, and 8% had cytopenia. The course of CMV positive cases was similar to CMV negative cases: 1 of 3 cases of CMV cases was steroid refractory, 1 of 3 cases was immediately treated with biologics, and no case progressed to colectomy. In CMV negative cases, 20 of 77 were steroid refractory, 32 of 77 received biologics, and 9 of 77 underwent colectomy. Conclusion: Only 3 out of 80 cases of acute severe colitis were found to have CMV infection, a figure lower than in previous studies. In our study, there was a non-significant trend towards CMV infection with prior high dose steroids, age < 40 years, and IBD duration < 1 year. No risk factors were statistically significant, likely due to the small sample size. Additional studies are needed to readdress the issue of whether testing for CMV infection in a patient with acute severe colitis is beneficial.