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