Predictive Scores Can Help Identify IBD Patients At Risk for Cytomegalovirus

Scoring systems can be useful in predicting risk for patients with concurrent cytomegalovirus (CMV) in inflammatory bowel disease (IBD)-related colitis, a new study finds. Using such predictive scores are seen as important for minimizing high consumption of resources as well as addressing potential delays in treatment.

CMV in patients with IBD has a low incidence rate, yet the investigators of the study noted that testing all patients for the virus is associated with unacceptable overusing of resources. Therefore, more efficient diagnosing measures need to be taken.

Investigators at Jena University Hospital in Germany performed a retrospective single center study, which included all IBD patients with available data on CMV-PCR analysis in whole blood. They evaluated the diagnostic accuracy of the Berlin Score and the Münster Score, both of which are prognostic scores for CMV infection. The study was conducted between 2010-2018.

Overall, they identified a total of 907 patients with IBD and CMV-PCR. Of the total, 21 patients (2.3%) presented with positive CMV (≥ 1000 copies/mL).

Furthermore, 14 of the CMV-positive patients had ulcerative colitis, and 7 had Chron’s disease.

The investigators found that the Berlin Score identified 667 patients (73.1%) as potentially CMV-positive. Therefore, the positive predictive value was 2.5%, and the negative predicative value was 98.3%.

On the contrary, the Münster Score identified 60 patients as potentially CMV-positive, therefore resulting in a positive predictive value of 20% and negative predictive value of 99.4%.

“Scoring systems can help to identify patients at risk for a CMV infection and minimize resource consumption and delay in treatment,” they concluded. “Due to low incidence, a 2-step-algorithm, consisting of the Münster Score followed by a CMV-PCR if the score indicates a CMV infection, is preferable.”

CMV is associated with high rates of colectomy and other morbidities.

A study that was published last year found that patients with ulcerative colitis and infections, such as CMV, had high rates of morbidity and mortality.

This study noted that the length of hospital stays among patients with ulcerative colitis and CMV flares was 11.47 days—versus only 4.71 days in those with only ulcerative colitis.

Additionally, in-hospital morbidities in ulcerative colitis patients with and without CMV infections were 0.3% and 0.55%

The investigators of this study also found that the colectomy rate in the ulcerative colitis plus CMV cohort was 9.98%—compared with only 1.71% in the ulcerative colitis cohort.

They concluded by acknowledging that immunocompromised patients with ulcerative colitis are a population of particular concern since contracting infections such as CMV or even C. diff. can potentially lead to poorer prognoses.

The study, “Are CMV-predictive scores in inflammatory bowel disease useful in clinical practice?” was published online in Thieme.