Is CMV DNAemia an early marker of CMV colitis in patients with active ulcerative colitis?

IF 3.7 2区生物学 Q2 MICROBIOLOGY Microbiology spectrum Pub Date : 2024-11-05 Epub Date: 2024-10-14 DOI:10.1128/spectrum.01159-24

Laura Melotti, Matteo Rinaldi, Marco Salice, Nikolas K Dussias, Nicholas Vanigli, Carlo Calabrese, Eleonora Scaioli, Liliana Gabrielli, Tiziana Lazzarotto, Francesca Rosini, Pierluigi Viale, Paolo Gionchetti, Maddalena Giannella, Fernando Rizzello

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Abstract

Cytomegalovirus (CMV) colitis is a serious concern worsening the prognosis of patients with ulcerative colitis (UC). We aimed to assess risk factors and prognostic impact of CMV colitis in patients with moderate-to-severe UC flare. We conducted a retrospective, observational, single-center study. Consecutive adult patients hospitalized for moderate-to-severe UC from January 2020 to June 2023 were included. The primary endpoint was a diagnosis of CMV-colitis according to immunohistochemistry on tissue biopsies. The secondary endpoint was the need for colectomy within 30 days. Overall, 135 patients were included. CMV colitis was diagnosed in n = 37 (27.4%): n = 19 (51.4%) endoscopically, the remaining on surgical specimens. Of them, n = 23 (62.2%) had positive CMV-DNAemia with a median value of 1,008 cp/mL (interquartile range 318-2,980). Differences between the two groups (CMV colitis vs non-CMV) included age (60 vs 41 years, P = 0.004), Charlson Comorbidity Index (1 vs 0, P = 0.003), steroid refractoriness (86.5% vs 62.2%, P = 0.007), and positive CMV-DNAemia (62.2% vs 10.1%, P < 0.001). At multivariable analysis, steroid-refractory disease, Charlson Comorbidity Index, and CMV-DNAemia were associated with CMV colitis. Overall, n = 54 (39.7%) patients underwent colectomy, and this was significantly more common in patients with CMV colitis vs non-CMV group (54.1% vs 34.4%, P = 0.049). Kaplan-Meier showed that antiviral therapy seems to have a relevant impact on colectomy (P < 0.001). CMV-DNA blood detection is independently associated with CMV-positive refractory UC. Since CMV colitis may increase the risk of colectomy and antiviral treatment seems to reduce such risk, prospective studies are needed to confirm the role of CMV-DNA blood detection to early diagnose CMV colitis.

Importance: Cytomegalovirus (CMV) colonic reactivation worsens the prognosis of patients with active ulcerative colitis. Blood CMV-DNA reactivation is strongly associated with CMV colitis. Prompt diagnosis and treatment of CMV colitis can avoid surgery in most cases.

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CMV DNA 血症是活动性溃疡性结肠炎患者 CMV 结肠炎的早期标志物吗？

巨细胞病毒（CMV）结肠炎严重影响溃疡性结肠炎（UC）患者的预后。我们的目的是评估中重度 UC 爆发患者患 CMV 结肠炎的风险因素和对预后的影响。我们进行了一项回顾性、观察性、单中心研究。研究纳入了 2020 年 1 月至 2023 年 6 月期间因中度至重度 UC 住院的连续成年患者。主要终点是根据组织活检的免疫组化结果确诊为 CMV 结肠炎。次要终点是 30 天内是否需要进行结肠切除术。共纳入 135 名患者。37人（27.4%）确诊为CMV结肠炎：19人（51.4%）通过内窥镜确诊，其余人通过手术标本确诊。其中，n = 23（62.2%）人的 CMV-DNA 血症呈阳性，中位值为 1,008 cp/mL（四分位间范围 318-2,980）。两组（CMV 结肠炎 vs 非 CMV）之间的差异包括年龄（60 岁 vs 41 岁，P = 0.004）、Charlson 合并症指数（1 vs 0，P = 0.003）、类固醇难治性（86.5% vs 62.2%，P = 0.007）和 CMV-DNAemia 阳性（62.2% vs 10.1%，P < 0.001）。在多变量分析中，类固醇难治性疾病、Charlson疾病综合指数和CMV-DNA血症与CMV结肠炎相关。总体而言，54 例（39.7%）患者接受了结肠切除术，CMV 结肠炎患者接受结肠切除术的比例明显高于非 CMV 组（54.1% vs 34.4%，P = 0.049）。卡普兰-梅耶显示，抗病毒治疗似乎对结肠切除术有相关影响（P < 0.001）。CMV-DNA血液检测与CMV阳性难治性UC独立相关。由于CMV结肠炎可能会增加结肠切除术的风险，而抗病毒治疗似乎可以降低这种风险，因此需要进行前瞻性研究，以确认CMV-DNA血液检测对早期诊断CMV结肠炎的作用：巨细胞病毒（CMV）结肠再激活会恶化活动性溃疡性结肠炎患者的预后。血液中的 CMV-DNA 再激活与 CMV 结肠炎密切相关。及时诊断和治疗巨细胞病毒结肠炎可以避免大多数情况下的手术治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microbiology spectrum Biochemistry, Genetics and Molecular Biology-Genetics

CiteScore

3.20

自引率

5.40%

发文量

1800

期刊介绍： Microbiology Spectrum publishes commissioned review articles on topics in microbiology representing ten content areas: Archaea; Food Microbiology; Bacterial Genetics, Cell Biology, and Physiology; Clinical Microbiology; Environmental Microbiology and Ecology; Eukaryotic Microbes; Genomics, Computational, and Synthetic Microbiology; Immunology; Pathogenesis; and Virology. Reviews are interrelated, with each review linking to other related content. A large board of Microbiology Spectrum editors aids in the development of topics for potential reviews and in the identification of an editor, or editors, who shepherd each collection.