Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis

Table 1 Clinical and demographic characteristics of patients with active ulcerative colitis (n = 149)

	CMV (+) n = 34	CMV (-) n = 115	P value
Sex (male/female)	19/15	64/51	0.981
Age at UC diagnosis (yr)	42.3 ± 14.4	29.0 ± 14.4	< 0.001
Age at admission (yr)	46.9 ± 18.1	35.0 ± 15.6	< 0.001
Disease duration (yr)	4.6 ± 4.9	6.0 ± 7.4	0.294
Clinical course
Relapse	23 (67.6%)	79 (68.7%)	0.908
Chronic active	4 (11.8%)	11 (9.6%)	0.708
First attack	7 (20.6%)	25 (21.7%)	0.886
Disease extent
Extensive UC (pancolitis)	28 (82%)	52 (45%)	< 0.001
Left-sided UC/proctitis	6 (18%)	63 (55%)	-
BMI at admission	19.5 ± 3.2	18.9 ± 3.1	0.384
Severity
Severe	11 (32%)	27 (23%)	0.297
Moderate	23 (68%)	88 (77%)	-
Laboratory data at admission
CRP (mg/dL)	3.4 ± 4.1	3.8 ± 5.4	0.685
WBC (× 103/μL)	8.7 ± 3.7	9.9 ± 4.2	0.132
Hemoglobin (g/dL)	11.4 ± 1.8	11.7 ± 1.2	0.387
Platelet (× 103/μL)	321.0 ± 118.9	349.9 ± 120.2	0.219
Total cholesterol (mg/dL)	155.3 ± 39.7	155.1 ± 44.3	0.979
Albumin (g/dL)	3.0 ± 0.54	3.4 ± 0.68	0.002
Medication
Total lifetime systemic steroid dose before admission (g)	4.69 ± 5.80	4.86 ± 8.45	0.892
Total systemic steroid dose for 4 wk before admission (mg)	1083.4 ± 1113.5	245.5 ± 328.4	< 0.001
Total systemic steroid dose for 1 wk before admission (mg)	260.7 ± 103.9	92.3 ± 117.0	< 0.001
Systemic steroid dose on the day at admission (mg)	37.5 ± 15.0	13.9 ± 17.6	< 0.001
5-ASA	29 (85.3%)	82 (71.3%)	0.100
SASP	1 (2.9%)	10 (8.7%)	0.260
Cytapheresis	5 (15%)	11 (9.6%)	0.395
Immunomodulator use	8 (24%)	20 (17%)	0.421
AZA	4 (12%)	16 (14%)	0.747
6-MP	2 (5.9%)	2 (1.7%)	0.177
Tacrolimus	2 (5.9%)	2 (1.7%)	0.177
Infliximab use	5 (15%)	7 (6.1%)	0.105
Family history of IBD	1 (2.9%)	1 (0.87%)	0.356
PSC	0	2 (1.7%)	-
Outcome
Ganciclovir use	26 (76%)	0	-
Colectomy	17 (50%)	37 (32%)	0.058
Colectomy for cancer or dysplasia	0	4 (3.5%)	-

Values presented as mean ± SD or number (%) as appropriate. CMV: Cytomegalovirus; CRP: C-reactive protein; WBC: White blood count; BMI: Body mass index; 5-ASA: 5-aminosalicylate acid; SASP: Salicylazosulfapyridine; AZA: Azathioprine; 6-MP: 6-mercaptopurine; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; PSC: Primary sclerosing cholangitis.

Table 2 Risk factors for cytomegalovirus-associated colitis among the 149 patients with active ulcerative colitis (multivariate analysis)

	Odds ratio	95%CI	P value
Age at UC diagnosis > 30 yr	2.764	0.581-13.152	0.202
Age at admission > 35 yr	1.433	0.295-6.951	0.655
Pancolitis	3.419	1.077-10.856	0.037
Albumin < 3.0 g/dL	1.402	0.480-4.098	0.537
Total systemic steroid dose for 4 wk before admission > 400 mg	26.697	5.848-121.868	< 0.001

UC: Ulcerative colitis; CMV: Cytomegalovirus.

Table 3 Endoscopic findings in patients with active ulcerative colitis (n = 149)

	CMV (+) n = 34	CMV (-) n = 115	Accuracy (%)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	P value
Deep ulcer	17 (50.0%)	14 (12.2%)	79.2	50.0	87.8	54.8	85.6	< 0.001
Punched-out ulcer	20 (58.8%)	8 (7.0%)	85.2	58.8	93.0	71.4	88.4	< 0.001
Geographical ulcer	14 (41.2%)	25 (21.7%)	76.5	41.2	78.2	35.9	81.8	0.024
Longitudinal ulcer	11 (32.4%)	24 (20.9%)	68.5	32.4	79.1	31.4	79.8	0.165
Mucosal defect	6 (17.6%)	10 (8.7%)	74.5	17.6	91.3	37.5	78.9	0.139
Mucopurulent exudate	24 (70.6%)	66 (57.4%)	49.0	70.6	42.6	26.7	83.1	0.167
Spontaneous bleeding	14 (41.2%)	19 (16.5%)	73.8	41.2	83.5	42.4	82.8	0.002
Cobblestone-like appearance	5 (14.7%)	7 (6.1%)	75.8	14.7	93.9	41.7	78.8	0.105
Post inflammatory polyp	9 (26.5%)	21 (18.3%)	75.8	26.5	81.7	30.0	79.0	0.294

PPV: Positive predictive value; NPV: Negative predictive value; CMV: Cytomegalovirus.

Table 4 Characteristic endoscopic findings for cytomegalovirus-associated colitis in patients with active ulcerative colitis (multivariate analysis)

	Odds ratio	95%CI	P value
Deep ulcer	2.128	0.678-6.680	0.196
Punched-out ulcer	12.672	4.210-38.143	< 0.001
Geographical ulcer	1.919	0.664-5.542	0.229
Spontaneous bleeding	2.106	0.735-6.036	0.166