title: Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis.
abstract: BACKGROUND
  Cytomegalovirus (CMV) colitis can contribute to an unfavorable outcome of acute severe ulcerative colitis (ASUC). The purpose of this study was to evaluate the clinical outcomes of ASUC according to the CMV status and identify risk factors for CMV colitis in patients with ASUC.
  
  
  METHODS
  We retrospectively analyzed patients with ASUC from 2011 to 2014 according to the criteria of Truelove and Witts. CMV colitis was diagnosed by histopathological and/or immunohistochemical analysis of tissue samples. The risk factors for CMV colitis were investigated and clinical outcomes were assessed using the rate of rescue therapy and colectomy.
  
  
  RESULTS
  Of 149 patients with ASUC, 50 (33.6%) were diagnosed with CMV colitis. During admission, 16 of 149 patients (10.7%) underwent colectomy: 7 of 50 (14.0%) in the ASUC-CMV group versus 9 of 99 (9.1%) in the ASUC-only group (P = 0.364). The need for rescue therapy was 2.28-fold higher in the ASUC-CMV group than in the ASUC-only group in multivariate analysis (95% confidence interval, 1.10-4.72). Multivariate analysis also revealed that recent use of high-dose steroids (odds ratio, 3.30; 95% confidence interval, 1.33-8.19) and a higher Mayo score (odds ratio, 1.58; 95% confidence interval, 1.05-2.38) were risk factors for CMV colitis.
  
  
  CONCLUSIONS
  CMV colitis often occurs in ASUC, particularly in patients who have recently been treated with high-dose steroids and have a higher Mayo score on admission. Patients with ASUC and CMV colitis seem to have a poorer prognosis, as indicated by the greater need for rescue therapy.
authors.affiliation: *Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and Departments of †Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, ‡Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, §Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, and ‖Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Ho-Su
authors.initials: HS
authors.lastname: Lee
authors.forename: Sang Hyoung
authors.initials: SH
authors.lastname: Park
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Jihun
authors.initials: J
authors.lastname: Kim
authors.forename: Jene
authors.initials: J
authors.lastname: Choi
authors.forename: Hyo Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Wan Soo
authors.initials: WS
authors.lastname: Kim
authors.forename: Jeong-Mi
authors.initials: JM
authors.lastname: Lee
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Kwak
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Hwang
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D003587:Cytomegalovirus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult