P263 Prognostic value of the magnitude of cytomegalovirus reactivation evaluated by immunohistochemistry in patients with ulcerative colitis
A. Clos1, P. Rodríguez-Martínez2, M. Manyosa3, A. Ruiz-Cerulla4, M. J. Paúles5, J. Llaó6, J. Gordillo6, C. Fumagalli7, T. Lobatón3, I. Ojanguren2, E. Cabré3, J. Guardiola4, E. Domènech*3
1Hospital Universitari Germans Trias i Pujol, Gastroenterology, Badalona, Spain, 2Hospital Universitari Germans Trias i Pujol, Pathology, Badalona, Spain, 3Hospital Germans Trias i Pujol. CIBEREHD, Gastroenterology, Badalona, Spain, 4Hospital de Bellvitge. IDIBELL, Gastroenterology, L’Hospitalet de Llobregat, Spain, 5Hospital de Bellvitge., Pathology, L’Hospitalet de Llobregat, Spain, 6Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain, 7Hospital de la Santa Creu i Sant Pau, Pathology, Barcelona, Spain
Cytomegalovirus (CMV) reactivation in the colon has been involved in steroid refractoriness in patients with ulcerative colitis (UC). Its diagnosis is based on the detection of CMV by means of specific immunohistochemistry (IHC) or polymerase chain reaction (PCR) on rectal biopsies. Although the benefit of antiviral therapy in this clinical setting is still under debate, a threshold of CMV copies by PCR has been associated with a poorer outcome. Our aim was to assess whether the intensity of CMV reactivation measured by the number of positive cells by IHC is associated with the short-term prognosis in these patients.
UC patients with IHC-CMV+ were identified in 3 different hospitals. All the biopsies were reviewed by expert pathologists and the maximum number of cell IHQ-CMV+ in each biopsy sample was determined. Baseline and evolutive clinical variables were recorded.
We included 48 patients, with a median age of 40 years (IQR 32–55). 67% had extensive UC, 25% presented severe activity and the median time of UC duration at the index flare was 26 months (IQR 2–73). At CMV reactivation, 70% were receiving corticosteroids, 22% azathioprine, and 19% anti-TNF agents. The median number of IHC-CMV+ cells was 2 cells/biopsy (IQR 1–5). No factors were associated with the magnitude of the reactivation. Thirty-two patients (67%) were treated with antiviral therapy. Thirteen patients (27%) underwent colectomy; persistence of CMV was reported in 6/13 (46%) of the surgical specimens. The colectomy during admission for the index flare was significantly higher in patients with > 2 cells/biopsy (50% vs 16%, p = 0.022) and in patients with more severe activity (58% vs 19%, p = 0.01).
The intensity of CMV colonic reactivation in patients with refractory UC, as measured by IHC, could be of prognostic relevance. Our data, together with a previous rectal PCR study, suggest that the decision to start antiviral treatment might rely on the quantitative measure of CMV reactivation.