Clinical Presentation and Risk Factors for Cytomegalovirus Colitis in Immunocompetent Adult Patients
CID
Clinical Presentation and Risk Factors for Cytomegalovirus Colitis in Immunocompetent Adult Patients
Jae-Hoon Ko 2 3
Kyong Ran Peck () 2 3
Woo Joo Lee 2 3
Ji Yong Lee 2 3
Sun Young Cho 2 3
Young Eun Ha 2 3
Cheol-In Kang 2 3
Doo Ryeon Chung 2 3
Young-Ho Kim 1 2
Nam Yong Lee 0 2
Kyoung-Mee Kim 2 4
Jae-Hoon Song 2 3
0 Department of Laboratory Medicine
1 Division of Gastroenterology
2 Received 1 September 2014; accepted 22 November 2014; electronically published 1 December 2014. partment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81, Irwon-ro, Gangnam-gu, Seoul 135-710 , Korea
3 Division of Infectious Diseases
4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
Background. Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ disease, which has typically been described in immunocompromised hosts. Recently, it has been noted that this also occurs in immunocompetent patients. To gather relevant data about clinical presentation, prognosis, and risk factors for development of CMV colitis in immunocompetent hosts, we analyzed all cases that occurred during a 19-year period at our institution. Methods. A case-control study was performed to identify risk factors for CMV colitis in immunocompetent hosts. Electronic medical records of individuals who were admitted and diagnosed with CMV colitis between January 1995 and February 2014 at a tertiary care university hospital were reviewed. Two non-CMV colitis patients who were age- and sex-matched were selected as controls for each case. Results. A total of 51 patients with CMV colitis were included in this study along with 102 control patients. Certain conditions including renal disease on hemodialysis, neurologic disease, rheumatologic disease, intensive care unit admission, and exposure to antibiotics, antacids, steroids, or red blood cell (RBC) transfusions within 1 month of diagnosis of colitis were associated with CMV colitis on univariate analysis. Among these, steroid use and RBC transfusion within 1 month were identified as independent risk factors for developing CMV colitis on multivariate analysis. The 30-day mortality rate was 7.8% without any attributable mortality. Conclusions. Steroid use and RBC transfusion within 1 month of the diagnosis of colitis were independent risk factors for development of CMV colitis in immunocompetent hosts. Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ disease, which is associated with significant morbidity, such as abdominal pain, diarrhea, GI bleeding, and colon perforation [1, 2]. Although it has typically been described in immunocompromised patients such as those with human
cytomegalovirus; colitis; blood transfusion; steroids; risk factors
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immunodeficiency virus (HIV) infection, solid organ
transplant (SOT), ulcerative colitis, or malignancy [3
9], there have been several descriptive case series
among immunocompetent hosts [1012]. One study
evaluated outcomes of CMV colitis in 44
immunocompetent patients via literature search [13]. However, data
regarding risk factors for development of CMV colitis
and clinical characteristics in immunocompetent hosts
have not yet been reported. As clinical suspicion and
endoscopic examination are essential for the diagnosis
of CMV colitis [12], there is a clear need for these data.
To this end, all cases of CMV colitis presenting during a
19-year period at our center were analyzed to evaluate
risk factors for development of CMV colitis and its
clinical presentation in immunocompetent hosts.
Study Design and Patient Selection
A case-control study was designed to identify the clinical
presentation and risk factors for development of CMV colitis in
adult immunocompetent patients. We reviewed the electronic
medical records of individuals who were admitted and
diagnosed with CMV colitis between January 1995 and February
2014 at Samsung Medical Center, Seoul, Republic of Korea.
This is a 1950-bed tertiary care university hospital and referral
center. This study included patients with CMV colitis who were
aged >19 years at the time of diagnosis. Patients with HIV
infection, ulcerative colitis, or a history of SOT were excluded.
Cancer patients were also excluded, with the exception of
those who had been in complete remission for >5 years. To
establish a control group, we screened all adult patients who were
admitted to the hospital with a clinical diagnosis of colitis. Two
Variables
Data are expressed as No. (%) of patients unless indicated otherwise.
Abbreviations: CMV, cytomegalovirus; IgG, immunoglobulin G; IgM,
immunoglobulin M; IQR, interquartile range; WBC, white blood cell.
age- and sex-matched control patients were selected for each
case patient. Exclusion criteria were the same as those used
for case patients.
Data Collection
We collected the following data from the electronic medical
records: age, sex, body mass index (BM (...truncated)