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IMPACT OF CMV DETECTION IN COLONIC BIOPSIES ON CLINICAL OUTCOMES IN ACUTE SEVERE ULCERATIVE COLITIS

Carmen Tung 1, Michael Yulong Wu 1, Christopher John Kiely 1, Steffanie Nario 1

Affiliations

1 Royal North Shore Hospital, St Leonards, Australia

Summary

AI Generated

In this 10-year retrospective study of 133 acute severe ulcerative colitis presentations, CMV-positive patients (8%) required significantly more intensive interventions but showed no significant difference in colectomy or mortality rates compared to CMV-negative patients.

CMV-positive patients had significantly longer hospital stay (27.1 vs 11.0 days, p=0.003), higher ICU admission rates (27% vs 5%, p=0.004), greater need for TPN (36% vs 11%, p=0.02), and more frequent referral to colorectal surgery (82% vs 43%, p=0.01).
No significant differences were observed between CMV-positive and CMV-negative groups in rates of rescue therapy, inpatient colectomy, 90-day readmission, or 90-day mortality.
Patients on maintenance biologic therapy had significantly higher rates of CMV positivity (24% vs 7%, p=0.02), while small molecule inhibitors alone showed no significant association.
82% of CMV-positive patients were treated with ganciclovir or valganciclovir.
This study is relevant to gastroenterologists managing acute severe ulcerative colitis and considering CMV screening and treatment protocols.

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Abstract

Introduction

Patients with ulcerative colitis (UC) are at an increased risk of cytomegalovirus (CMV) infection. CMV infection in acute severe ulcerative colitis (ASUC) may worsen disease severity and clinical outcomes. Current guidelines recommend colonic biopsies for the exclusion of CMV in all patients with ASUC. One study found that CMV positivity in ASUC was associated with greater need for rescue therapy, longer hospital length of stay (LOS) and higher readmission rates but found no difference in rate of colectomy.¹ We aimed to investigate the impact of positive CMV result on clinical outcomes in patients presenting with ASUC.

Aims & Methods

A retrospective review included all ASUC presentations to a quaternary hospital over a 10-year period based on modified Truelove and Witts’ criteria. ASUC presentations were grouped based on CMV positivity as determined by colonic biopsy. Data on pre-admission medications was collected. Data was collected on rates of rescue therapy, referral to colorectal surgery, colectomy, total parenteral nutrition (TPN). Outcomes assessed included intensive care unit (ICU) admission, 30- and 90-day readmission rates, 30- and 90-day mortality rates and mean LOS.

Results

A total of 172 ASUC presentations were identified. Of these, 133 had available colonic biopsy CMV results. 11 patients (8%) had positive CMV. Positive CMV result was significantly associated with increased need for TPN (36% vs 11%, p=0.02), ICU admission (27% vs 5%, p=0.004) and referral to colorectal surgery (82% vs 43%, p=0.01). Patients with CMV had longer LOS (27.1±14.0 vs 11.0±7.4, p=0.003). There were no significant differences in rates of rescue therapy, inpatient colectomy, readmission or mortality rates. 9 of the patients (82%) were treated with ganciclovir or valganciclovir. Patients on maintenance advanced UC therapies, including biologics and small molecule inhibitors, had significantly higher rate of CMV (22% vs 5%, p=0.01). Biologic therapy alone was associated with higher rate of CMV (24% vs 7%, p=0.02), whereas small molecule inhibitor alone was not (p=0.6). Pre-admission use of 5-aminosalicylates, high dose steroids, thiopurines or combination therapies were not associated with CMV positivity.

Table 1: Comparison data of clinical outcomes in ASUC between patients with and without CMV positivity on colonic biopsy

	CMV on biopsy		p-value
	Positive	Negative
Rescue therapy (n)	7 (64%)	44 (36%)	p=0.07
TPN (n)	4 (36%)	14 (11%)	p=0.02*
Referral to colorectal surgery (n)	9 (82%)	52 (43%)	p=0.01*
Inpatient colectomy (n)	3 (27%)	14 (11%)	p=0.13
ICU admission (n)	3 (27%)	6 (5%)	p=0.004*
Readmission at 90 days (n)	4 (40%)	23 (19%)	p=0.11
Mortality at 90 days (n)	1 (9%)	2 (2%)	p=0.11
Length of stay (days)	27.1 ± 14.0	11.0 ± 7.4	p=0.003*

Conclusion

Patients with CMV positive colonic biopsies tend to require more inpatient interventions, including increased need for TPN, ICU admission, referral to colorectal surgery and longer hospital length of stay. Despite more complex admission course of ASUC patients with concurrent CMV infection, these patients were not observed to have worse outcomes than those without CMV diagnosis. Maintenance biologic and small molecule inhibitor use was associated with higher rates of CMV, reflecting the immunosuppressant effects of advanced UC therapies. CMV detection needs to be considered as a potential exacerbating factor in disease severity.

References

1. Huang D, Rennie M, Krasovec A, Nagubandi S, Liu S, Ge E, Khehra B, Au M, Sivagnanam S, Kwan V, Rogge C, Mitrev N, Kariyawasam V. Impact of cytomegalovirus on outcomes in acute severe ulcerative colitis: a retrospective observational study. Ther Adv Chronic Dis. 2024 Mar 28;15:20406223241233203. doi: 10.1177/20406223241233203. PMID: 38560721; PMCID: PMC10981253.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Predicting outcomes in IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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How to define the hot spots?

Marjolijn Duijvestein 1

Affiliations

1 Radboudumc, Nijmegen, Netherlands

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

Is your GI-practice sustainable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Advancing IBD precision medicine: The next frontier

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Advancing IBD precision medicine: The next frontier

Bram Verstockt 1

Affiliations

1 University Hospitals Leuven and KU Leuven, Translational Research in Gastrointestinal Disorders - IB, Leuven, Belgium

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

IBD Mechanisms & Personalised Medicine

Session

The art of making clinical research precise: Predicting therapy response in IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Advancing IBD precision medicine: The next frontier

Bram Verstockt

Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

Thomas L. Bollen

Management of pregnant women with chronic liver disease: Key points of vigilance

Nathalie Ganne-Carrié

Detection and management of dysplasia in UC

Marietta Iacucci

Resmetirom and novel biomarkers

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

Andrea Anderloni 1, Thomas L. Bollen 2

Affiliations

1 San Matteo Hospital, Pavia, Italy

2 St. Antonius Ziekenhuis, Nieuwegein, Netherlands

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

A 360-degree appraisal of acute pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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How to define the hot spots?

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Marietta Iacucci

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Management of pregnant women with chronic liver disease: Key points of vigilance

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Management of pregnant women with chronic liver disease: Key points of vigilance

Nathalie Ganne-Carrié 1

Affiliations

1 Hôpital Jean Verdier, APHP et Université Paris 13, Paris, France

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Paediatrics

Session

Liver and pregnancy: Beware of dangerous liaisons

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

Thomas L. Bollen

Management of pregnant women with chronic liver disease: Key points of vigilance

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Detection and management of dysplasia in UC

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Detection and management of dysplasia in UC

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Detection and management of dysplasia in UC

Marietta Iacucci 1

Affiliations

1 University College Cork, Cork, Ireland

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology IBD

Session

Cancer and IBD: Mitigating risk among uncertainty

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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How to define the hot spots?

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Advancing IBD precision medicine: The next frontier

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Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

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Management of pregnant women with chronic liver disease: Key points of vigilance

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Resmetirom and novel biomarkers

Frank Tacke 1

Affiliations

1 Charité Universitaetsmedizin Berlin, Dept of Hepatology & Gastroenterology, Berlin, Germany

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

Therapy update: MASH and metabolic disorders

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Advancing IBD precision medicine: The next frontier

Bram Verstockt

Evolution of acute necrotising pancreatitis: Imaging, clinical decision-making, and management of complications

Thomas L. Bollen

Management of pregnant women with chronic liver disease: Key points of vigilance

Nathalie Ganne-Carrié

Detection and management of dysplasia in UC

Marietta Iacucci

Resmetirom and novel biomarkers

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