title: Cytomegalovirus Infection in Ulcerative Colitis is Related to Severe Inflammation and a High Count of Cytomegalovirus-positive Cells in Biopsy Is a Risk Factor for Colectomy.
abstract: OBJECTIVE
  Cytomegalovirus [CMV] infection often reactivates in the course of inflammatory bowel disease, but the significance of this remains disputable. Our aim was to evaluate whether severity of CMV colitis is associated with colectomy risk in ulcerative colitis [UC] patients. The secondary aim was to evaluate agreement between immunohistochemistry [IHC] and blood CMV polymerase chain reaction [PCR].
  
  
  METHODS
  UC patients with CMV assessment of the colon, hospitalised in a referral unit between 2005 and 2012 were retrospectively identified. The course and severity of the disease were analysed, with inflammation graded histologically across the range 0-3. The numbers of CMV IHC-positive cells per biopsy section were counted, and results for blood CMV PCR were also retrieved. Data on colectomies were also collected.
  
  
  RESULTS
  Of 141 patients, 95 were analysed, with 33 found to be CMV IHC-positive and 62 negative. The colectomy risk was significantly higher in patients with ≥ 5 IHC-positive cells, as opposed to those with none or less than 5 [p = 0.014] with median follow-up of 1.9 and 3.2 years, respectively. The CMV IHC-positive patients had lower haemoglobin [median 11.0g/dl vs 12.0; p = 0.028] and albumin [median 29.5g/l vs 33.1; p = 0.038] levels and more intense histological inflammation [p = 0.020] compared with CMV IHC-negative patients. There was substantial agreement between IHC and blood PCR [Cohen's kappa coefficient 0.72].
  
  
  CONCLUSIONS
  Five or more CMV IHC-positive cells per biopsy section were indicative of a greater colectomy risk. CMV infection was related to more severe inflammation. Blood CMV PCR is a useful tool in UC.
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology, Warsaw, Poland Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland ezagorowicz@wp.pl.
authors.forename: Edyta
authors.initials: E
authors.lastname: Zagórowicz
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology, Warsaw, Poland Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Bugajski
authors.affiliation: Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland.
authors.forename: Paulina
authors.initials: P
authors.lastname: Wieszczy
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology, Warsaw, Poland Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Pietrzak
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Microbiology, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Magdziak
authors.affiliation: Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Pathology and Laboratory Medicine, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Mróz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000956:Antigens, Viral / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology / Q000601:surgery; D003106:Colon / Q000473:pathology* / Q000821:virology*; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000956:Antigens, Viral; D015415:Biomarkers; D004279:DNA, Viral
keywords: Ulcerative colitis; colectomy risk; cytomegalovirus; immunohistochemistry; polymerase chain reaction