Cytomegalovirus infection is associated with worse outcomes in inflammatory boweldisease hospitalizations nationwide

Hendler SA1, Barber GE2, Okafor PN2, Chang MS3, Limsui D2, Limketkai BN4. Int J Colorectal Dis. 2020 Mar 2. doi: 10.1007/s00384-020-03536-8. [Epub ahead of print]


Author information

Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA. svhendler@gmail.com.

Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Department of Gastroenterology, Kaiser Permanente-San Francisco, San Francisco, CA, USA.

UCLA Center for Inflammatory Bowel Diseases, UCLA Vatche & Tamar Manoukian Divison of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, USA.


BACKGROUND: Cytomegalovirus (CMV) infection may complicate ulcerative colitis (UC) or Crohn's disease (CD) hospitalizations. Studies examining this relationship are often single-center examining short time periods.

AIMS: To quantify the prevalence of CMV and its impact on outcomes among UC and CD hospitalizations over time using nationwide administrative databases.

METHODS: The National Inpatient Sample and Nationwide Readmissions Database were analyzed to calculate CMV prevalence per 1000 UC and CD hospitalizations between 1998 and 2014. Univariable and multivariable logistic and linear regression were used to assess CMV's association with outcomes. Separate analyses examined effects from the introduction of anti-TNF therapy in UC in 2005, CD anatomic extent, and Clostridioides difficile infection.

RESULTS: Among UC, from 1998 to 2014, the prevalence of CMV infection rose from 1.4 to 6.3 per 1000 UC hospitalizations (p < 0.001), although this increase was not statistically significant for the years 2006 to 2014 (p = 0.07). Among CD, prevalence rose from 0.3 to 1.8 per 1000 CD hospitalizations (p < 0.001) from 1998 to 2014. CMV was independently associated with increased inpatient mortality (UC: odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.5; CD: OR 4.6, CI 1.5-13.7), colectomy in UC (OR 2.5, CI 1.9-3.3), and higher length of stay and costs.

CONCLUSION: CMV infection's prevalence among UC and CD hospitalizations is rising over time, but may have slowed after 2005 in UC. CMV is independently associated with increased inpatient mortality, length of stay, and hospital charges in UC and CD and with colectomy in UC.

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