# Incidence and Prognostic Factors for Colectomy in Acute Severe Ulcerative Colitis with Concomitant CMV Infection

## TL;DR

This study finds that about 25% of patients with severe ulcerative colitis and CMV infection undergo colectomy within a year, with anemia and vedolizumab treatment linked to higher surgery rates.

## Contribution

The study identifies anemia and vedolizumab treatment as novel predictors of colectomy in patients with acute severe ulcerative colitis and CMV infection.

## Key findings

- 24.4% of patients with ASUC and CMV infection required colectomy within 12 months.
- Anemia (hemoglobin < 12 g/dL) was significantly associated with higher colectomy probability.
- Vedolizumab treatment at diagnosis showed a trend toward increased colectomy likelihood.

## Abstract

Background/Objectives: Cytomegalovirus (CMV) is an opportunistic pathogen, complicating acute severe ulcerative colitis (ASUC), and its role in ASUC prognosis remains a debate. This study aims to report the rates and identify predictors for colectomy at 12 months, following an episode of ASUC with concomitant CMV colonic infection. Methods: This is a retrospective cohort study of patients with ASUC and CMV colonic infection confirmed by PCR or Immunohistochemistry. Baseline clinical, biochemical, endoscopic and disease-related characteristics were recorded. Patients were followed-up for 12 months to calculate the one-year colectomy rate. Predictors of colectomy were identified via multivariate logistic regression. Results: Forty-five cases of CMV colonic infection in 37 patients with ASUC were recorded [66.7% men, mean age: 47.0 years (SD = 18.5)]. At diagnosis, 20% were on monotherapy with advanced treatment and 37.8% on advanced treatment plus corticosteroids and/or immunomodulators. Twenty-three (51.1%) were receiving corticosteroids, while 17.8% did not receive any immunosuppressive agent. Forty (88.9%) patients were treated with ganciclovir and valganciclovir and one (2.2%) with foscarnet for at least 21 days. Eleven patients (24.4%) required colectomy, two (4.4%) during their initial hospitalization and nine (20%) during the follow-up period. The recurrence of CMV was recorded in nine (20.9%) cases, three of which required colectomy. Patients with hemoglobin < 12 g/dL (p = 0.023) and patients on vedolizumab at diagnosis (p = 0.050) had a higher probability of colectomy. Conclusions: We report a 25% one-year colectomy rate in our cohort with ASUC and superimposed CMV colonic infection. At baseline, anemia and vedolizumab treatment were associated with a higher probability of colectomy.