P274 Clinical manifestations, risk factors and prognostic factors of Cytomegalovirus Colitis in Inflammatory Bowel Disease patients
Hsieh, C.R.(1)*;Le, P.H.(2);Kuo, C.J.(2);Yeh , P.J.(3);Chiu, C.T.(2);
(1)Department of Internal Medicine- Chang Gung Memorial Hospital- Linkou Branch- Taiwan, Department of Internal Medicine, New Taipei city, Taiwan;(2)Department of Gastroenterology and Hepatology- Chang Gung Memorial Hospital- Linkou Branch- Taiwan, Department of Gastroenterology and Hepatology, New Taipei City, Taiwan;(3)Department of Pediatric Gastroenterology- Chang Gung Memorial Hospital- Linkou Branch- Taiwan, Department of Pediatric Gastroenterology, New Taipei City, Taiwan;
CMV colitis is associated with acute flare-up and poor prognosis in inflammatory bowel disease (IBD). However, few studies showed the clinical manifestations, risk factors, prognostic factors and the impact of anti-viral treatment of CMV colitis in IBD inpatients. Therefore, we aimed to comprehensively analyze these issues in this largest cohort study in Asia.
We retrospectively enrolled 118 IBD patients, including 42 CMV colitis and 76 non-CMV colitis, confirmed by CMV immunohistochemistry (IHC) staining from colonic tissue biopsy, from the pathology database in a 4000-bed tertiary medical center between January 2000 and May 2021. The patient characteristics, clinical manifestations, risk factors, prognostic factors and the impact of anti-viral treatment were analyzed.
Major clinical manifestations in the CMV group included bloody stool (75.6%), diarrhea (68.3%) and abdominal pain (61%). The risk factors of CMV colitis were hypoalbuminemia (p=0.008) and antibiotic exposure (p=0.029) (Table 1). Seventy-nine percent of patients with CMV colitis received anti-viral treatment. In view of overall IBD complications, biological failure (OR 4.034, CI 1.659-9.805, P=0.002) and antiviral agents use (OR 0.08, CI 0.008-0.787, P=0.03) were independent prognostic factors in multivariate analysis (Table 2). In CMV group, the patients receiving adequate anti-viral treatment (≧ 14 days) had significantly lower IBD complications (29.2% vs. 72.2%) than inadequate or no treatment, especially in Crohn’s disease (Table 3).
Hypoalbuminemia and antibiotics use were the risk factors for CMV colitis in IBD patients. CMV colitis and biological failure lead to more overall IBD complications. However, definitive diagnosis and adequate anti-viral therapy can decrease the overall IBD related complications.