Skip to main content

Advertisement

SpringerLink
Log in

Serum Cytomegalovirus Polymerase Chain Reaction Test Is a Valuable Negative Predictor of Infection in Acute Severe Ulcerative Colitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Diagnosis of cytomegalovirus (CMV) colitis in the setting of severe ulcerative colitis (UC) remains a clinical challenge. This study aimed to determine the utility of serum CMV polymerase chain reaction (PCR) as a non-invasive test for the diagnosis of CMV superinfection in patients hospitalized with UC.

Methods

This retrospective study included consecutive admitted patients with UC who had serum testing for CMV completed as part of standard hospital procedure and CMV colitis diagnosed by expert pathologists.

Results

Two hundred and six patients with UC were included; 13 patients (6%) had histologically confirmed CMV colitis. Eleven of 13 patients with CMV colitis (84%) and 3 of 193 (1.5%) patients without CMV colitis had a positive serum PCR test (p < 0.0001). ROC analysis showed that a CMV PCR level of 259 IU/mL had a sensitivity and specificity of 77% and 99%, respectively, for diagnosis of CMV colitis with an AUC of 0.9 (p < 0.0001). Serum CMV PCR level significantly correlated to the number of inclusion bodies on biopsy specimens with data available (n = 8) (r = 0.8, p = 0.02). CMV positivity did not predict the need for salvage therapy, admission or 1-year colectomy rates.

Conclusion

Serum CMV PCR has an excellent negative predictive value and demonstrates a strong correlation with CMV positivity on histology. This work supports a rationale for serum CMV PCR testing on admission to assess the risk of CMV colitis in patients with severe UC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All original data are available from the authors upon request.

References:

  1. Ho M. Epidemiology of cytomegalovirus infections. Rev Infect Dis. 1990;12:S701–S710.

    Article  PubMed  Google Scholar 

  2. Siegmund B. Cytomegalovirus infection associated with inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2017;2:369–376.

    Article  PubMed  Google Scholar 

  3. Kopylov U et al. Antiviral therapy in cytomegalovirus-positive ulcerative colitis: a systematic review and meta-analysis. World J Gastroenterol. 2014;20:2695.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shukla T, Singh S, Loftus EV, Bruining DH, McCurdy JD. Antiviral therapy in steroid-refractory ulcerative colitis with cytomegalovirus: systematic review and meta-analysis. Inflamm Bowel Dis. 2015;21:2718–2725.

    Article  PubMed  Google Scholar 

  5. Jones A et al. Effects of antiviral therapy for patients with inflammatory bowel disease and a positive intestinal biopsy forcytomegalovirus. Clin Gastroenterol Hepatol. 2015;13:949–955.

    Article  CAS  PubMed  Google Scholar 

  6. Clos-Parals A et al. Prognostic value of the burden of cytomegalovirus colonic reactivation evaluated by immunohistochemical staining in patients with active ulcerative colitis. J. Crohn’s Colitis 2019;13:385–388.

    Article  Google Scholar 

  7. Zagórowicz E et al. Cytomegalovirus infection in ulcerative colitis is related to severe inflammation and a high count of cytomegalovirus-positive cells in biopsy is a risk factor for colectomy. J. Crohn’s Colitis 2016;10:1205–1211.

    Article  Google Scholar 

  8. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114:384–413.

    Article  PubMed  Google Scholar 

  9. Pillet S et al. Infliximab does not worsen outcomes during flare-ups associated with cytomegalovirus infection in patients with ulcerative colitis. Inflamm Bowel Dis. 2015;21:1580–1586.

    Article  PubMed  Google Scholar 

Download references

Funding

This work received no funding.

Author information

Authors and Affiliations

  1. University of Chicago Medicine Inflammatory Bowel Disease Center, 5841 S. Maryland Avenue, MC4076, Chicago, IL, 60637, USA

    Nathaniel A. Cohen, Maryam Zafer, Namrata Setia, Michael J. Anderson, Atsushi Sakuraba, Sushila Dalal, Joel Pekow, Russell D. Cohen, David T. Rubin & Dejan Micic

Authors
  1. Nathaniel A. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maryam Zafer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Namrata Setia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael J. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Sakuraba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sushila Dalal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joel Pekow
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Russell D. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David T. Rubin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dejan Micic
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NAC, DMM: Study concept and design; NAC, MZ, MJA: Acquisition of data; NAC, NS, DMM: Analysis and interpretation of data; NAC: Drafting of manuscript; NS, DTR, DMM: Critical revision of manuscript.

Corresponding author

Correspondence to Dejan Micic.

Ethics declarations

Conflict of interest

NAC, NS, MZ, MJA and DM: no conflicts of interest. DTR: Received grant support from Takeda; and has served as a consultant for Abbvie, Abgenomics, Allergan Inc., Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences S.A., InDex Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Narrow River Mgmt, Pfizer, Prometheus Laboratories,Reistone, Takeda, and Techlab Inc. He is also co-founder of Cornerstones Health, Inc. and GoDuRn, LLC; on the Board of Trustees of the American College of Gastroenterology.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cohen, N.A., Zafer, M., Setia, N. et al. Serum Cytomegalovirus Polymerase Chain Reaction Test Is a Valuable Negative Predictor of Infection in Acute Severe Ulcerative Colitis. Dig Dis Sci 68, 897–901 (2023). https://doi.org/10.1007/s10620-022-07607-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-022-07607-4

Keywords

Search

Navigation