Effects of cytomegalovirus infection on the prognosis of inflammatory bowel disease patients

Abstract

The aim of the present study was to investigate the effects of cytomegalovirus (CMV) infection on the prognosis of inflammatory bowel disease (IBD). Various databases were searched using a combination of keywords associated with CMV infection and IBD. Subsequent to the selection of relevant studies in line with strict inclusion and exclusion criteria, a meta-analysis was conducted using the Stata 12.0 software. A total of 195 studies were initially retrieved, including 28 studies in Chinese and 167 in English. Following the exclusion of unsuitable studies, 7 cohort studies with 374 IBD patients were included in the meta-analysis. The results of the present study identified significant differences between patients with and without CMV infection regarding the disease duration of IBD [standardized mean difference, −0.81; 95% confidence interval (CI), −1.19 to −0.43; P<0.001], the efficacy of corticosteroid therapy [relative risk (RR), 1.24; 95% CI, 1.02–1.49; P=0.029], the colectomy rate (RR, 2.13; 95% CI, 1.03–4.40; P=0.042) and the incidence of severe IBD (RR, 1.32; 95% CI, 1.04–1.67; P=0.022). Considering the IBD onset area, patients with CMV infection may have higher susceptibility to pancolitis (RR, 1.31; 95% CI; 1.01–1.72; P=0.045); however, no difference in susceptibility to left-sided IBD was observed between patients with or without CMV infection (RR, 0.97; 95% CI, 0.72–1.30; P=0.828). In conclusion, CMV infection may be associated with the disease duration, efficacy of corticosteroid therapy, colectomy rate, severe IBD incidence and disease location of IBD; thus, the presence of CMV infection may be considered as an important biomarker for determining the prognosis of IBD.

ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications

“…26 A recent meta-analysis revealed that cytomegalovirus [CMV] infection in IBD may be associated with longer disease duration, reduced efficacy of corticosteroid therapy, and increased colectomy rate. 222 Corticosteroid and thiopurine exposure are associated with reactivation of latent CMV. 223 However, tissue damage following exposure to immunomodulators is rare.…”

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

“…Depending on the clinical setting, PCR for viral and parasitic agents may be considered. For example, IBD patients receiving immunosuppression are more prone to CMV colitis, which can be measured in serum and biopsies [ 25 ]. Blood cultures are mandatory.…”

Severe complication during remission of Crohn’s disease: hemophagocytic lymphohistiocytosis due to acute cytomegalovirus infection

“…Recent studies presume that CMV infections may have a significant role in the outcome of patients with inflammatory bowel diseases, especially if the patients undergo immunosuppressive treatment. Higher morbidity rates were observed in patients with present CMV infection and ulcerative colitis or Crohn's disease [12]. The European Crohn's and Colitis Organisation states in its recent guidelines that acute CMV infection due to reactivation of the virus under immunosuppression is common, but severe courses are rather rare.…”