P0529 - Utility of Serum Cytomegalovirus Polymerase Chain Reaction Test in the Setting of Acute Severe Ulcerative Colitis

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Nathaniel A. Cohen, MBBCh

University of Chicago Medicine Inflammatory Bowel Disease Center
Chicago, IL, United States

Nathaniel A. Cohen, MBBCh¹, Maryam Zafer, MD², Namrata Setia, MD³, Michael J. Andersen, ³, Atsushi Sakuraba, MD, PhD¹, Sushila R. Dalal, MD¹, Joel Pekow, MD¹, Russell D. Cohen, MD¹, David T. Rubin, MD, FACG⁴, Dejan Micic, MD¹
¹University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL; ²University of Chicago Medical Center, Chicago, IL; ³University of Chicago Medicine, Chicago, IL; ⁴University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL

Introduction: Cytomegalovirus (CMV) infection is often considered a treatable cause of exacerbations in ulcerative colitis (UC). However, the contribution of CMV to the severity of disease is often unclear. The aim of this study was to determine the utility of serum CMV polymerase chain reaction (PCR) as a non-invasive test for the diagnosis of CMV superinfection in acute severe UC (ASUC).

Methods: This retrospective study included consecutive UC patients admitted to University of Chicago Medicine with ASUC from 1/2013-12/2017. CMV colitis was diagnosed by expert pathologists by the presence of inclusion body on microscopy or positive immunohistochemistry from the biopsies taken during inpatient endoscopies. Spearman correlation was used to assess correlations between the number of inclusions and serum CMV PCR. ROC curves were used to determine sensitivity and specificity of the serum CMV PCR test (Roche cobas® 6800).

Results: 196 patients with ASUC were included in the analysis; 11 patients (6%) had histologically confirmed CMV colitis and all these patients received intravenous ganciclovir therapy. Demographic details are shown in Table 1. 9 of 11 patients with CMV colitis (81.8%) and 3 of 185 (2.6%) patients without CMV colitis had a positive serum PCR test (P < 0.001). Patients with CMV colitis had a significantly higher median CMV PCR (727 (IQR 137-2500) vs 0 (0), p< 0.0001) compared to those without infection. ROC analysis showed that a CMV PCR level of 286 IU/mL had a sensitivity and specificity of 73% and 99% respectively, for diagnosis of CMV colitis with an AUC of 0.9 (p< 0.0001). Serum CMV PCR level was significantly correlated to the number of inclusion bodies on biopsy specimens with data available (n=6) (r=0.83, p=0.04). Utilization of salvage therapy and colectomy rates in patients with CMV colitis compared with those without were similar (salvage: 62% vs 54%; admit colectomy: 18.2% vs 23.2%, 1-year colectomy: 36% vs 40%, p=n/s for all comparisons). Patients with concurrent CMV colitis had significantly longer hospitalizations (median 13.5 (IQR 5-16) vs 8 (4.1-11) days, p=0.05).

Discussion: In this study, serum CMV PCR level was significantly correlated with the number of inclusion bodies on biopsies and a level of > 286 IU/mL had excellent ability to diagnose the CMV colitis suggesting that its utility in clinical practice. Further study will be required to unravel the contribution of true CMV infection in the exacerbation of UC.

Variable	CMV pos (n=11)	CMV neg (n=185)	p-value
Age - median (IQR)	37.5 (32.2-66.1)	32.5 (23.9-45.2)	0.096
Disease duration (years) - median (IQR)	5.8 (1.26-10.5)	2.96 (0.86-8.1)	0.4
Biologic naïve - n(%)	4 (36)	78 (42)	0.53
Disease location			0.6
Proctitis - n(%)	0 (0)	16 (9)
Left sided colitis - n(%)	4 (36)	52 (28)
Extensive colitis - n(%)	7 (64)	117 (63)
Length of hospitalization - median (IQR)	13.8 (5-16)	8 (4.1-11)	0.05
CMV PCR - median (IQR)	727 (137-2500)	0 (0)	>0.0001
Number of inclusion bodies - mean (±SD)	8 (7.4)	n/a	n/a
Laboratory results on admission
Hemoglobin (g/dL) - median (IQR)	10.9 (8.4-13.6)	11.6 (10-13.1)	0.44
Albumin (g/dL) - median (IQR)	3 (2.5-3.3)	3.4 (2.9-3.9)	0.02
C-reactive protein (mg/L) - median (IQR)	9 (7-29)	25 (4-52)	0.32
Colectomy - n(%)	4 (36.4)	74 (40)	1
Gender			0.35
Female - n(%)	3 (27)	83 (44.9)
Male - n(%)	8 (72.7)	102 (55.1)
Race
White - n (%)	9 (81.8)	142 (77.6)	1

Table: Table 1: Disease characteristics of the patient cohort

Disclosures:

Nathaniel Cohen indicated no relevant financial relationships.

Maryam Zafer indicated no relevant financial relationships.

Namrata Setia indicated no relevant financial relationships.

Michael Andersen indicated no relevant financial relationships.

Atsushi Sakuraba indicated no relevant financial relationships.

Sushila Dalal: Abbvie – Advisory Committee/Board Member, Speaker's Bureau. Pfizer – Advisory Committee/Board Member, Consultant.

Joel Pekow: Abbvie – Grant/Research Support. CVS Caremark – Advisory Committee/Board Member. Genentech – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Grant/Research Support. Verasatem – Consultant.

Russell Cohen: Abbvie – Consultant, Speaker's Bureau. BMS Celgene – Consultant. Eli Lilly – Consultant. Genentech – Consultant. Gilead Sciences – Consultant. Hoffmann La-Roche – Consultant. Janssen – Consultant. Pfizer – Consultant. Takeda – Consultant, Speaker's Bureau. UCB Pharma – Consultant.

David Rubin: Abbvie – Consultant. Allergan, Inc. – Consultant. Altrubio – Consultant. Arena Pharmaceuticals – Consultant. Athos Therapeutics – Consultant. Bellatrix Pharmaceuticals – Consultant. Boehringer Ingelheim, Ltd. – Consultant. Bristol-Myers Squibb – Consultant. Celgene Corp/Syneos – Consultant. Connect BioPharma – Consultant. GalenPharma/Atlantica – Consultant. Genentech/Roche – Consultant. Gilead Sciences – Consultant. InDex Pharmaceuticals – Consultant. Ironwood Pharmaceuticals – Consultant. Iterative Scopes – Consultant. Janssen Pharmaceuticals – Consultant. Lilly – Consultant. Materia Prima – Consultant. Pfizer – Consultant. Prometheus Biosciences – Consultant. Reistone – Consultant. Takeda – Consultant, Grant/Research Support. Techlab, Inc. – Consultant.

Dejan Micic indicated no relevant financial relationships.

Nathaniel A. Cohen, MBBCh¹, Maryam Zafer, MD², Namrata Setia, MD³, Michael J. Andersen, ³, Atsushi Sakuraba, MD, PhD¹, Sushila R. Dalal, MD¹, Joel Pekow, MD¹, Russell D. Cohen, MD¹, David T. Rubin, MD, FACG⁴, Dejan Micic, MD¹. P0529 - Utility of Serum Cytomegalovirus Polymerase Chain Reaction Test in the Setting of Acute Severe Ulcerative Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.