Abstract
Background
Cytomegalovirus (CMV) infection may complicate ulcerative colitis (UC) or Crohn’s disease (CD) hospitalizations. Studies examining this relationship are often single-center examining short time periods.
Aims
To quantify the prevalence of CMV and its impact on outcomes among UC and CD hospitalizations over time using nationwide administrative databases.
Methods
The National Inpatient Sample and Nationwide Readmissions Database were analyzed to calculate CMV prevalence per 1000 UC and CD hospitalizations between 1998 and 2014. Univariable and multivariable logistic and linear regression were used to assess CMV’s association with outcomes. Separate analyses examined effects from the introduction of anti-TNF therapy in UC in 2005, CD anatomic extent, and Clostridioides difficile infection.
Results
Among UC, from 1998 to 2014, the prevalence of CMV infection rose from 1.4 to 6.3 per 1000 UC hospitalizations (p < 0.001), although this increase was not statistically significant for the years 2006 to 2014 (p = 0.07). Among CD, prevalence rose from 0.3 to 1.8 per 1000 CD hospitalizations (p < 0.001) from 1998 to 2014. CMV was independently associated with increased inpatient mortality (UC: odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2–4.5; CD: OR 4.6, CI 1.5–13.7), colectomy in UC (OR 2.5, CI 1.9–3.3), and higher length of stay and costs.
Conclusion
CMV infection’s prevalence among UC and CD hospitalizations is rising over time, but may have slowed after 2005 in UC. CMV is independently associated with increased inpatient mortality, length of stay, and hospital charges in UC and CD and with colectomy in UC.
Similar content being viewed by others
References
Vega R, Bertrán X, Menacho M, Domènech E, Moreno de Vega V, Hombrados M, Cabré E, Ojanguren I, Gassull MA (1999) Cytomegalovirus infection in patients with inflammatory bowel disease. Am J Gastroenterol 94:1053–1056
Johnson J, Affolter K, Boynton K et al (2018) CMV disease in IBD: comparison of diagnostic tests and correlation with disease outcome. Inflamm Bowel Dis 24:1539–1546
Roblin X, Pillet S, Oussalah A et al (2011) Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis. Am J Gastroenterol 106:2001–2008
Shukla T, Singh S, Loftus EVJ et al (2015) Antiviral therapy in steroid-refractory ulcerative colitis with cytomegalovirus: systematic review and meta-analysis. Inflamm Bowel Dis 21:2718–2725
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD (2019) ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol 114:384–413
Romkens TE, Bulte GJ, Nissen LH et al (2016) Cytomegalovirus in inflammatory bowel disease: a systematic review. World J Gastroenterol 22:1321–1330
Hahn G, Jores R, Mocarski ES (1998) Cytomegalovirus remains latent in a common precursor of dendritic and myeloid cells. Proc Natl Acad Sci U S A 95:3937–3942
Nakase H, Chiba T (2010) TNF-alpha is an important pathogenic factor contributing to reactivation of cytomegalovirus in inflamed mucosa of colon in patients with ulcerative colitis: lesson from clinical experience. Inflamm Bowel Dis 16:550–551
Powell RD, Warner NE, Levine RS et al (1961) Cytomegalic inclusion disease and ulcerative colitis; report of a case in a young adult. Am J Med 30:334–340
Kornbluth A, Sachar DB, American College of Gastroenterology, Practice Parameters Committee (1997) Ulcerative colitis practice guidelines in adults. Am J Gastroenterol 92:204–211
Kornbluth A, Sachar DB (2004) Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 99:1371–1385
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD (2019) ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol 114:384–413
Gauss A, Rosenstiel S, Schnitzler P, Hinz U, Rehlen T, Kadmon M, Ehehalt R, Stremmel W, Zawierucha A (2015) Intestinal cytomegalovirus infection in patients hospitalized for exacerbation of inflammatory bowel disease: a 10-year tertiary referral center experience. Eur J Gastroenterol Hepatol 27:712–720
McCurdy JD, Jones A, Enders FT, Killian JM, Loftus EV, Smyrk TC, Bruining DH (2015) A model for identifying cytomegalovirus in patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology 13:131–137
Lawlor G, Moss AC (2010) Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis 16:1620–1627
Garrido E, Carrera E, Manzano R, Lopez-Sanroman A (2013) Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease. World J Gastroenterol 19:17–25
Roblin X, Pillet S, Berthelot P et al (2012) Prevalence of cytomegalovirus infection in steroid-refractory Crohn’s disease. Inflamm Bowel Dis 18:E1397
Grossberg L, Ezaz G, Grunwald D et al (2016) A national survey of the prevalence and impact of cytomegalovirus infection among hospitalized patients with ulcerative colitis. J Clin Gastroenterol 52:241
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical considerations
The current study was exempt by our Institutional Review Board due to its use of publicly available anonymous data.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 23 kb)
Rights and permissions
About this article
Cite this article
Hendler, S.A., Barber, G.E., Okafor, P.N. et al. Cytomegalovirus infection is associated with worse outcomes in inflammatory bowel disease hospitalizations nationwide. Int J Colorectal Dis 35, 897–903 (2020). https://doi.org/10.1007/s00384-020-03536-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-020-03536-8