P289 Cytomegalovirus reactivation in ulcerative colitis is related to severe inflammatory activity
E. Zagorowicz*1, M. Bugajski*1, A. Mróz2, A. Pietrzak1, A. Magdziak3, P. Wieszczy4
1Institute of Oncology, Gastroenterology, Warsaw, Poland, 2Institute of Oncology, Histopathology, Warsaw, Poland, 3Institute of Oncology, Microbiology, Warsaw, Poland, 4Medical Centre for Postgraduate Education, Warsaw, Poland
Background
Cytomegalovirus (CMV) infection often reactivates in the course of inflammatory bowel disease, but clinical significance of this remains a matter of debate.
Immunohistochemistry (IHC) or polymerase chain reaction (PCR) CMV DNA in colonic tissue are recommended diagnostic tests, but more rapid blood PCR CMV DNA is increasingly used.
Our primary aim was to analyse clinical features and colectomy rate in ulcerative colitis (UC) patients with CMV infection diagnosed by IHC and compare them to CMV-negative UC patients.
The secondary aim was to evaluate agreement between IHC and blood qualitative or quantitative PCR CMV DNA tests in diagnosing of CMV reactivation.
Methods
Using the electronic pathology database, all UC patients hospitalised a single unit between 1995 and 2012, in whom histopathologic CMV evaluation was requested by an endoscopist, were identified. The previous disease course and severity at admission (haemoglobin, platelets, albumin and CRP, and Mayo Endoscopic Score) were analysed in the CMV-positive and negative patients. Severity of inflammation was histologically assessed by use of a 4-grade scale (0–3). Results of other performed CMV tests were retrieved. Data on colectomies performed in the 2 groups were collected.
Results
We analysed 95 patients: 33 (34.7%) IHC CMV-positive, and 62 (65.3%) IHC CMV-negative. The CMV-positive had lower haemoglobin [median 11.0 (interquartile range [ICR] 2.1 vs 12.0 [3.3], p = 0.028) and albumin (median 29.5 [ICR 11.5] vs 33.1 [10.6], p = 0.038) level on admission and higher grade of histological inflammation compared with the CMV-negative (grade 3, 40.0% vs 23.7%; grade 2, 46.7% vs 33.9%; and grade 0 or 1, 13.3% vs 42.4%, p = 0.020). Ganciclovir treatment was completed by 22 (66%) patients from the CMV-positive group and 1 (1.6%) patient from CMV-negative group (positive in blood PCR). The colectomy-free survival was similar in both groups (p = 0.141), with median follow-up of 3.4 years in the CMV-positive and 2.6 years in the CMV-negative group. Colectomy was less likely in left-sided than extensive colitis (p = 0.035) and in patients who received immunosuppression on inclusion (p = 0.006). There was a substantial agreement between IHC and blood PCR in CMV diagnosis with the Cohen’s kappa coefficient of 0.72.
Conclusion
Lower haemoglobin and albumin levels and more severe histological inflammation were seen in the UC patients with IHC proven CMV reactivation compared with the CMV-negative. Colectomy-free survival was similar in both groups. Ganciclovir treatment might have contributed to the results. There was a substantial agreement between the colonic IHC and blood PCR CMV DNA test used for CMV diagnosing.