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P320 High Cytomegalovirus DNA load in mucosal biopsies predicts steroid failure as well as colectomy in acute severe ulcerative colitis

S. Jain1, D. Namdeo1, S. Kedia1, P. Sahu1, P. Das1, P. Sahni1, N. R. Dash1, S. Pal1, G. Makharia1, L. Dar1, V. Ahuja*1

1All India Institute of Medical Sciences, New Delhi, India

Background

Cytomegalovirus (CMV) reactivation may be responsible for steroid refractory acute severe colitis (ASC), which requires rescue therapy in form of surgery or advanced immunosuppression. The optimum technique for diagnosing CMV colitis in this setting remains unclear. We investigated the role of CMV Quantitative PCR for diagnosing CMV colitis and for predicting of steroid-failure in ASC.

Methods

Consecutive patients with ASC satisfying Truelove and Witts’ criteria, hospitalised at a single-centre from May 2016 to November 2017, were included. The primary outcome measure was steroid-failure defined as colectomy and/or rescue therapy with cyclosporine or infliximab during admission. Oxford criteria, ulcerative colitis index of severity (UCEIS) at Day 1 and faecal calprotectin (FCP) at Day 3 were used to predict steroid response. Immunohistochemistry (IHC) and quantitative PCR for CMV was done on mucosal biopsies and the results were compared between steroid responders and non-responders.

Results

Of 37 patients (Mean age: 35 ± 12 years, 70% males), 14(38%) failed iv corticosteroids and 8(25%) required surgery. Although IHC for CMV was not different between steroid failures and responders (29% vs 17%, p = 0.40), patients with steroid failure had a significantly higher median level of mucosal CMV DNA [7840 (0–2700 000) vs. 112 (0–34459) copies/mg, p = 0.03]. Significantly greater number of patients with steroid failure had CMV DNA count >1000 copies/mg (71% vs. 26%, p = 0.007). CMV DNA count >1000 copies/mg (odds ratio 6.5 (95% confidence interval 1.3–33, p = 0.03)) and positive oxford criterion on Day 3 of iv corticosteroids (OR 6 (95% CI 1.2–30, p = 0.03)) were independent predictors of steroid-failure and need for rescue therapy/colectomy.

Conclusion

CMV DNA quantification in mucosal biopsy can detect CMV colitis and predict steroid failure in acute severe colitis with reasonable accuracy.