P032 The incidence of Cytomegalovirus in acute severe colitis in hospitalized patients with inflammatory bowel disease

BACKGROUND: An association between cytomegalovirus (CMV) and acute severe inflammatory bowel disease (IBD) colitis has been demonstrated in prior studies. However, it is unclear whether this association indicates CMV as a causative pathogen in triggering severe flares. This study aimed to assess the incidence of CMV in IBD patients admitted to a community-based, safety-net hospital for acute severe colitis and evaluate risk factors and outcomes for CMV colitis. METHODS: A retrospective case control study involving all IBD patients admitted from 2013-2017 to a county hospital with acute severe colitis. Data was collected from the hospital's electronic medical record. Data extracted included demographics, IBD type, symptoms on admission, and types of medications used including steroids or biologic therapy. We calculated odds ratios (OR) and confidence intervals for multiple risk factors. RESULTS: Among 45 IBD patients, there were 80 separate hospitalizations that met criteria for acute severe colitis based on Truelove and Witt's criteria. CMV infection was detected in 3 out of 80 (4%) admissions. 67% and 33% of CMV cases had received prior treatment with high dose steroids & biologics respectively, compared to 33% & 29% of cases without CMV infection (OR 4.16, P-value 0.25; OR 1.25, P-value 0.86). Of patients with CMV infection, 67% had ulcerative colitis (UC), 33% Crohn's Disease (CD), 100% were age < 40, 33% were male and 67% female, none had cancer or HIV, and 33% had cytopenia. Of patients without CMV infection, 71% had UC, 29% had CD, 52% were age < 40, 58% were male and 42% female, 1% had cancer, 1% had HIV, and 8% had cytopenia. The course of CMV positive cases was similar to CMV negative cases: 1 of the 3 cases of CMV cases was steroid refractory, 1 of 3 cases was immediately treated with biologics, and no case progressed to colectomy. In CMV negative cases, 20 of 77 were steroid refractory, 32 of 77 received biologics, and 9 of 77 underwent colectomy. CONCLUSION(S): Three out of 80 cases of acute severe colitis were found to have CMV infection, a figure lower than in previous studies. In our study, CMV is infrequently associated with colitis and of those who had CMV, none required colectomy. Of the risk factors that were evaluated, none were significantly associated with CMV colitis though this may be due to the small number of cases. Of note, there was a non-significant trend towards CMV infection with prior high dose steroids, age < 40 years, and IBD duration < 1 year. More prospective studies are needed to evaluate the true risk of CMV infection in acute severe colitis.