Cytomegalovirus Reactivation in Ulcerative Colitis Patients: Early Indicators

Abstract

Background: The association of cytomegalovirus (CMV) infection with ulcerative colitis (UC) still remains a controversial topic for the  clinicians.

Aim: In this study, we aimed to elucidate the CMV infection related parameters in the exacerbation of UC.

Material and  Methods: In this study, 812 UC patients who have admitted to our institution between June 2008 and November 2020 were analyzed  retrospectively. CMV infection was diagnosed by the detection of CMV DNA with polymerase chain reaction (PCR) in tissue biopsies with  presence of clinical colitis symptoms. CMV negative UC patient group was defined as UC activation group with negative PCR results.   

Result: A total of 153 patients met the inclusion criteria during the study period, with a median age of 41.8 years. CMV PCR positivity had  been detected in tissue biopsy in 43 (28.1%) UC patients. CMV‑positive patients had a statistically significant higher frequency of steroid resistance, treatment with azathioprine, longer disease duration, longer remission, and hospitalization day. The mean C-reactive protein  (CRP) level, platelet to lymphocyte ratio (PLR) were higher, and mean albumin level was lower in CMV positive patients, with statistically  significance. Also, colectomy and anti‑tumor necrosis factor-α (TNF‑α) therapy were more frequent in CMV-reactivated group in long-term  follow-up. In a multivariable model, steroid resistance, treatment with azathioprine, long disease duration, low albumin value was  independently associated with colonic CMV infection.

Conclusion: Steroid resistance, treatment with azathioprine, long disease duration,  low albumin levels were significant risk factors for CMV colitis, among patients with UC activation.