P355 Prevalence, clinical characteristics and outcomes of CMV colitis in a cohort of 95 patients with ulcerative colitis: A 7-year retrospective analysis

Abstract Background Cytomegalovirus (CMV) infection in ulcerative colitis (UC) is common during relapses however true CMV colitis is rare. It poses as a clinical challenge since no optimal method for clinical relevant CMV infection has been determined even though current recommendations agree on histology/immunohistochemistry (IHQ). However these parameters require extensive biopsies for diagnosis and are not readily available in most centres. Therefore a clinical based decision seems peremptory. Methods Clinical, laboratory, endoscopic, and pathological data of patients with UC admitted to the emergency department (ER) or hospitalised for an acute exacerbation and who underwent evaluation for CMV in colonic tissue between January 2010 and October of 2017 were retrospectively analysed. The diagnosis of CMV colonic infection was based on identification of CMV by histopathology, IHQ or tissue CMV-PCR. CMV colitis was defined by a clinical response after initiation of antiviral therapy. Clinical severity of UC was assessed according to Mayo scoring index. Fisher’s exact test was used to compare continuous variables and Mann–Whitney test for continuous variables. A p < 0.05 was considered statistically significant. Results During the study period there were 137 evaluations for CMV infection in colonic tissue that corresponded to 95 patients. Of these 20 patients (21%) showed the presence of CMV in colonic tissue—CMV infection (controls) and 6 patients (6.3%) had CMV colitis (cases). Patients with CMV colitis had a statistically higher frequency of deep ulceration on admission endoscopy (83.3% vs. 21.4% p = 0.018), higher Mayo Scores on admission (p = 0.015), a steroid-refractory disease course (66.7% vs. 0% p = 0.003) and presence of blood viral load (66.7% vs. 0% p = 0.05) than patients with CMV colonic infection alone. AUC for Mayo Score and blood viral load in predicting CMV colitis was 0.845 (95% CI 0.67 – 1.0, p = 0.017) and 0.833 (95% CI 0.59–1, p = 0.025) respectively. There were no significant differences between the two groups in terms of age, gender, disease duration, immunosuppression therapies, presentation symptoms (fever, diarrhoea, rectal bleeding), laboratory parameters (leucocytes, C-reactive protein, platelets or serum albumin), and outcomes (readmission in the ER, hospitalisation and colectomy). Conclusions Patients that present with acute flares with deep ulceration on endoscopy and higher Mayo Scores associated to a steroid refractory cour