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. 2021 Apr 6:2021:8886525.
doi: 10.1155/2021/8886525. eCollection 2021.

Clinical Features, Endoscopic Findings, and Predictive Factors for Mortality in Tissue-Invasive Gastrointestinal Cytomegalovirus Disease between Immunocompetent and Immunocompromised Patients

Panu Wetwittayakhlang  1 , Natthapat Rujeerapaiboon  1 , Poowadon Wetwittayakhlung  2 , Pimsiri Sripongpun  1 , Nannapat Pruphetkaew  3 , Sawangpong Jandee  1 , Naichaya Chamroonkul  1 , Teerha Piratvisuth  4
Affiliations

Clinical Features, Endoscopic Findings, and Predictive Factors for Mortality in Tissue-Invasive Gastrointestinal Cytomegalovirus Disease between Immunocompetent and Immunocompromised Patients

Panu Wetwittayakhlang et al. Gastroenterol Res Pract. .

Abstract

Background and aims: Tissue-invasive gastrointestinal cytomegalovirus (TI-GI CMV) disease is common in immunocompromised patients, but the increasing prevalence in immunocompetent patients has been reported. This study compared the clinical manifestations, endoscopic features, treatment outcomes, and predictors for inhospital mortality of TI-GI CMV between immunocompromised and immunocompetent patients.

Methods: Patients with HIV infection, malignancy, or receiving immunosuppressive agents (chemotherapy, high dose, or long-term corticosteroids) were defined as the immunocompromised group. Demographic and inhospital mortality data were obtained and retrospectively analyzed.

Results: A total of 213 patients (89 immunocompetent) with histologically confirmed TI-GI CMV were enrolled. Immunocompetent patients were older (70 vs. 52 years; p < 0.001), had more GI bleeding as a presenting symptom (47.2% vs. 29.0%; p = 0.010), and shorter symptom onset (2 vs. 14 days, p = 0.018). Concomitant extra-GI involvement was only seen in the immunocompromised group (6.5% vs. 0%; p = 0.02). Diffuse GI tract (14.5% vs. 4.5%; p = 0.032) and esophageal involvement (14.5% vs. 5.6%; p = 0.046) were more frequent in the immunocompromised, while small bowel involvement was more frequent in the immunocompetent group (19.1% vs. 8.1%; p = 0.029). An overall inhospital mortality was 27.7%. There was no significant difference in inhospital survival probability between the two groups (Peto-Peto test, p = 0.65). ICU admission (hazard ratio [HR] 7.21; 95% CI 2.55-20.36), sepsis or shock (HR 1.98; 95% CI 1.08-3.66), malnutrition (HR 2.62; 95% CI 1.05-7.01), and receiving chemotherapy (HR 5.2; 95% CI 1.89-14.29) were independent factors for inhospital mortality. Antiviral treatment for more than 14 days was the only protective factor to improve survival (Peto-Peto test, p < 0.001).

Conclusions: Immunocompetent and immunocompromised patients with TI-GI CMV disease had distinct clinical and endoscopic characteristics. There was no significant difference in the inhospital mortality between the two groups. The factors for mortality were ICU admission, sepsis/shock, malnutrition, and receiving chemotherapy. Early diagnosis and initiation of antiviral treatment might improve the survival probability.

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Conflict of interest statement

All authors declare no conflict of interest related to the present study.

Figures

Figure 1
Figure 1
Study flow chart. Abbreviations: CMV: cytomegalovirus; GI: gastrointestinal; TI: tissue invasive.
Figure 2
Figure 2
Kaplan–Meier survival curve of inhospital survival probability in immunocompetent and immunocompromised patients.
Figure 3
Figure 3
Survival probability of patients receiving antiviral treatment at different duration.
See this image and copyright information in PMC

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References

    1. Ison M. G. Editorial commentary: diagnosis of gastrointestinal cytomegalovirus infections: an imperfect science. Clinical Infectious Diseases. 2013;57(11):1560–1561. doi: 10.1093/cid/cit524. - DOI - PubMed
    1. Rafailidis P. I., Mourtzoukou E. G., Varbobitis I. C., Falagas M. E. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virology Journal. 2008;5(1):p. 47. doi: 10.1186/1743-422X-5-47. - DOI - PMC - PubMed
    1. Lawlor G., Moss A. C. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflammatory Bowel Diseases. 2010;16(9):1620–1627. doi: 10.1002/ibd.21275. - DOI - PubMed
    1. Lancini D., Faddy H. M., Flower R., Hogan C. Cytomegalovirus disease in immunocompetent adults. Medical Journal of Australia. 2014;201(10):578–580. doi: 10.5694/mja14.00183. - DOI - PubMed
    1. Kotton C. N., Kumar D., Caliendo A. M., et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900–931. doi: 10.1097/TP.0000000000002191. - DOI - PubMed

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