Gauss Annika, Rosenstiel Simon, Schnitzler Paul, Hinz Ulf, Rehlen Tobias, Kadmon Martina, Ehehalt Robert, Stremmel Wolfgang, Zawierucha Anna
Departments of aGastroenterology bInfectious Diseases, Virology cSurgery, University Hospital Heidelberg dOutpatient Clinic of Gastroenterology, Heidelberg, Germany.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):712-20. doi: 10.1097/MEG.0000000000000361.
This 10-year retrospective cohort study aims to determine the prevalence and risk factors of cytomegalovirus (CMV) infection in inpatients with exacerbated inflammatory bowel disease (IBD).
All patients admitted to the Department of Gastroenterology of the University Hospital Heidelberg for IBD exacerbation between January 2004 and June 2013 were enrolled. To identify the risk factors of CMV infection, infected individuals were compared with those with excluded infection.
Among 297 patients with exacerbated IBD, 21 had confirmed CMV infection and 79 had excluded CMV infection, whereas the remaining patients had not been sufficiently tested for CMV. Taking into account only sufficiently tested individuals, the prevalence of CMV infection was 22.7% in ulcerative colitis and 16.0% in Crohn's disease. The occurrence of CMV infection was associated with the following variables at admission: age of 30 years or more [odds ratio (OR) 14.29; P=0.004], disease duration less than 60 months (OR 7.69; P=0.011), a blood leukocyte count less than 11/nl (OR 4.49; P=0.041), and immunosuppressive therapy (OR 6.73; P=0.0129). CMV-positive patients remained in the hospital longer than noninfected patients (P=0.0009). In the CMV-positive cohort, a 66-year-old woman died of CMV pneumonia and sepsis, whereas there was no death in the CMV-negative cohort.
Immunuosuppressive therapy and age older than 30 years were identified as the main risk factors for the development of CMV infection in exacerbated IBD. Because of the risk of death, diagnostics of CMV infection should especially be initiated in older patients on immunosuppressive therapy.
这项为期10年的回顾性队列研究旨在确定炎症性肠病（IBD）病情加重的住院患者中巨细胞病毒（CMV）感染的患病率及危险因素。
纳入2004年1月至2013年6月期间因IBD病情加重入住海德堡大学医院胃肠病科的所有患者。为确定CMV感染的危险因素，将感染个体与排除感染的个体进行比较。
在297例IBD病情加重的患者中，21例确诊为CMV感染，79例排除CMV感染，其余患者未进行充分的CMV检测。仅考虑检测充分的个体，溃疡性结肠炎中CMV感染的患病率为22.7%，克罗恩病中为16.0%。CMV感染的发生与入院时的以下变量相关：年龄30岁及以上[比值比（OR）14.29；P = 0.004]、病程小于60个月（OR 7.69；P = 0.011）、血白细胞计数小于11/nl（OR 4.49；P = 0.041）以及免疫抑制治疗（OR 6.73；P = 0.0129）。CMV阳性患者住院时间比未感染患者更长（P = 0.0009）。在CMV阳性队列中，一名66岁女性死于CMV肺炎和败血症，而CMV阴性队列中无死亡病例。
免疫抑制治疗和年龄大于30岁被确定为IBD病情加重时发生CMV感染的主要危险因素。由于存在死亡风险，对于接受免疫抑制治疗的老年患者尤其应启动CMV感染的诊断。
