Clinical characteristics of cytomegalovirus colitis: a 15-year experience from a tertiary reference center

Puo-Hsien Le,1,2 Wey-Ran Lin,1,3 Chia-Jung Kuo,1–3 Ren-Chin Wu,3,4 Jun-Te Hsu,3,5 Ming-Yao Su,1–3 Chun-Jung Lin,1 Cheng-Tang Chiu1–3 1Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, 2Taiwan Association for the Study of Small Intestinal Diseases, 3College of Medicine, Chang Gung University, 4Department of Pathology, 5Department of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Background: Cytomegalovirus (CMV) colitis is considered rare in immunocompetent patients.Objective: The predictors of mortality and the differences between immunocompetent and immunocompromised patients with this disease remain unknown. Thus, the aim of this retrospective cohort study was to clarify these issues.Patients and methods: We enrolled all patients who were histologically diagnosed with CMV colitis between April 2002 and December 2016 in the Linkou Chang Gung Memorial Hospital. Patients were divided into two groups: immunocompetent and immunocompromised, and the differences between them were analyzed to develop in-hospital mortality predictors.Results: A total of 69 patients (42, immunocompetent; 27, immunocompromised) were enrolled. The most common symptoms were melena in the immunocompetent group and diarrhea in the immunocompromised group. The in-hospital mortality rate showed no statistically significant difference between the two groups (26.2% vs 25.9%, P=0.981). Early diagnosis was the only significant independent predictor of in-hospital mortality (odds ratio [OR] 1.075, 95% CI 1.005–1.149, P=0.035). The cutoff of diagnostic timing was 9 days from admission, derived from the receiver operating characteristic curve using the Youden index.Conclusion: CMV colitis in immunocompetent patients is markedly more common and fatal than has generally been acknowledged. Being alert to different ways in which this disease can present itself will enable early diagnosis and significantly reduce mortality. Keywords: cytomegalovirus colitis, immunocompetent, immunocompromise