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Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome

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Zeitschriftentitel: BMJ Open Gastroenterology
Personen und Körperschaften: Mavropoulou, Eirini, Ternes, Kristin, Mechie, Nicolae-Catalin, Bremer, Sebastian Christopher Benjamin, Kunsch, Steffen, Ellenrieder, Volker, Neesse, Albrecht, Amanzada, Ahmad
In: BMJ Open Gastroenterology, 6, 2019, 1, S. e000258
Format: E-Article
Sprache: Englisch
veröffentlicht:
BMJ
Schlagwörter:
Gastroenterology
author_facet Mavropoulou, Eirini
Ternes, Kristin
Mechie, Nicolae-Catalin
Bremer, Sebastian Christopher Benjamin
Kunsch, Steffen
Ellenrieder, Volker
Neesse, Albrecht
Amanzada, Ahmad
Mavropoulou, Eirini
Ternes, Kristin
Mechie, Nicolae-Catalin
Bremer, Sebastian Christopher Benjamin
Kunsch, Steffen
Ellenrieder, Volker
Neesse, Albrecht
Amanzada, Ahmad
author Mavropoulou, Eirini
Ternes, Kristin
Mechie, Nicolae-Catalin
Bremer, Sebastian Christopher Benjamin
Kunsch, Steffen
Ellenrieder, Volker
Neesse, Albrecht
Amanzada, Ahmad
spellingShingle Mavropoulou, Eirini
Ternes, Kristin
Mechie, Nicolae-Catalin
Bremer, Sebastian Christopher Benjamin
Kunsch, Steffen
Ellenrieder, Volker
Neesse, Albrecht
Amanzada, Ahmad
BMJ Open Gastroenterology
Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
Gastroenterology
author_sort mavropoulou, eirini
spelling Mavropoulou, Eirini Ternes, Kristin Mechie, Nicolae-Catalin Bremer, Sebastian Christopher Benjamin Kunsch, Steffen Ellenrieder, Volker Neesse, Albrecht Amanzada, Ahmad 2054-4774 BMJ Gastroenterology http://dx.doi.org/10.1136/bmjgast-2018-000258 <jats:sec><jats:title>Background</jats:title><jats:p>Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The sensitivity of quantitative PCR (qPCR) with a cut-off value of &gt;250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and &gt;2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and &gt;2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.</jats:p></jats:sec> Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome BMJ Open Gastroenterology
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title Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_unstemmed Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_full Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_fullStr Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_full_unstemmed Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_short Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_sort cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
topic Gastroenterology
url http://dx.doi.org/10.1136/bmjgast-2018-000258
publishDate 2019
physical e000258
description <jats:sec><jats:title>Background</jats:title><jats:p>Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The sensitivity of quantitative PCR (qPCR) with a cut-off value of &gt;250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and &gt;2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and &gt;2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.</jats:p></jats:sec>
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author Mavropoulou, Eirini, Ternes, Kristin, Mechie, Nicolae-Catalin, Bremer, Sebastian Christopher Benjamin, Kunsch, Steffen, Ellenrieder, Volker, Neesse, Albrecht, Amanzada, Ahmad
author_facet Mavropoulou, Eirini, Ternes, Kristin, Mechie, Nicolae-Catalin, Bremer, Sebastian Christopher Benjamin, Kunsch, Steffen, Ellenrieder, Volker, Neesse, Albrecht, Amanzada, Ahmad, Mavropoulou, Eirini, Ternes, Kristin, Mechie, Nicolae-Catalin, Bremer, Sebastian Christopher Benjamin, Kunsch, Steffen, Ellenrieder, Volker, Neesse, Albrecht, Amanzada, Ahmad
author_sort mavropoulou, eirini
container_issue 1
container_start_page 0
container_title BMJ Open Gastroenterology
container_volume 6
description <jats:sec><jats:title>Background</jats:title><jats:p>Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The sensitivity of quantitative PCR (qPCR) with a cut-off value of &gt;250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and &gt;2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and &gt;2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.</jats:p></jats:sec>
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spelling Mavropoulou, Eirini Ternes, Kristin Mechie, Nicolae-Catalin Bremer, Sebastian Christopher Benjamin Kunsch, Steffen Ellenrieder, Volker Neesse, Albrecht Amanzada, Ahmad 2054-4774 BMJ Gastroenterology http://dx.doi.org/10.1136/bmjgast-2018-000258 <jats:sec><jats:title>Background</jats:title><jats:p>Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The sensitivity of quantitative PCR (qPCR) with a cut-off value of &gt;250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and &gt;2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and &gt;2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.</jats:p></jats:sec> Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome BMJ Open Gastroenterology
spellingShingle Mavropoulou, Eirini, Ternes, Kristin, Mechie, Nicolae-Catalin, Bremer, Sebastian Christopher Benjamin, Kunsch, Steffen, Ellenrieder, Volker, Neesse, Albrecht, Amanzada, Ahmad, BMJ Open Gastroenterology, Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome, Gastroenterology
title Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_full Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_fullStr Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_full_unstemmed Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_short Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_sort cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
title_unstemmed Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
topic Gastroenterology
url http://dx.doi.org/10.1136/bmjgast-2018-000258