Table 1.
Characteristics of patients with gastrointestinal cytomegaloviral infection
| Immunocompetent (n = 56) | Immunocompromised (n = 117) | P | |
|---|---|---|---|
| Age, year (mean ± SD) | 73.0 ± 13.9 | 48.6 ± 16.4 | <.0001 |
| Male gender | 31 (55.4%) | 72 (61.5%) | 0.44 |
| Immunocompromised conditions | |||
| HIV infection | 0 | 34 (29.1%) CD4 (median 19, 1–187) | |
| Transplantation | 0 | 24 (20.5%) | |
| Cancers receiving chemotherapy | 0 | 21 (17.9%) | |
| Autoimmune diseases | 2 (3.6%) (not receive steroid, immunosuppressant) | 30 (25.6%) | |
| Inflammatory bowel diseases (CD = 3, UC = 8) | 1 (1.8%) (not receive steroid, immunosuppressant) | 10 (8.6%) | |
| Other conditions requiring corticosteroids | 8 (6.8%) | ||
| a10 patients had two underlying conditions | |||
| Medications | |||
| Corticosteroids | 0 | 70 (40.5%) | |
| Chemotherapy | 0 | 21 (18.0%) | |
| Immunosuppressive agents | 0 | 44 (37.6%) | |
| Underlying diseases | |||
| Diabetes mellitus | 20 (35.7%) | 21 (18.0%) | 0.010 |
| Large vessel atherosclerotic diseases | 21 (37.5%) | 14 (12.0%) | < 0.0001 |
| Chronic kidney disease | 13 (23.2%) | 28 (23.9%) | 0.917 |
|
• Stage 3 • Stage 4 • Stage 5 |
6 (46.2%) 1 (7.6%) 6 (46.2%) |
6 (21.4%) 5 (17.9%) 17 (60.7%) |
0.244 |
| Cirrhosis | 2 (3.6%) | 4 (3.4%) | >.99 |
|
• Child-Pugh A • Child-Pugh B • Child-Pugh C |
0 (0%) 1 (50%) 1 (50%) |
1 (25%) 3 (75%) 0 (0%) |
0.269 |
| Status conditions at diagnosis | |||
| Clinical Setting | 0.024 | ||
|
• Outpatient • Inpatient • Intensive care |
23 (41.1%) 21 (37.5%) 12 (21.4%) |
69 (59.0%) 38 (32.5%) 10 (8.6%) |
|
| Bacteremia | 4 (7.1%) | 11 (9.4%) | 0.776 |
| Systemic inflammatory response syndrome | 29 (52.7%) | 53 (45.7%) | 0.39 |
| Respiratory failure | 20 (35.7%) | 25 (21.4%) | 0.04 |
| Inotropic drugs | 19 (33.9%) | 10 (8.6%) | <.0001 |
| Acute renal failure | 22 (39.3%) | 26 (22.2%) | 0.02 |
| Presentation | |||
| Median presenting duration, days (range) | 1 (1–60) | 10 (1–210) | 0.0015 |
| GI bleeding | 40 (71.4%) | 45 (38.5%) | <.0001 |
| Diarrhea | 18 (32.1%) | 63 (53.8%) | 0.007 |
| Abdominal pain | 9 (16.1%) | 39 (33.3%) | 0.018 |
| Fever | 27 (49.1%) | 66 (56.4%) | 0.369 |
| Severe ileus | 4 (7.1%) | 3 (2.6%) | 0.215 |
| Perforation | 1 (1.8%) | 3 (2.6%) | >.99 |
| CMV at other organs | 0 (0%) | 8 (6.8%) | 0.055 |
| Investigations | |||
| CMV viral load (n = 112) | |||
| • Median (range, IQR) | 370 (0–85,599, 4951) | 2736 (0–2,988,940, 27,074) | 0.010 |
| • CMV VL = 0 | 11/27 (40.7%) | 11/85 (12.9%) | 0.002 |
| Location involvement | |||
| Esophagus | 4 (7.1%) | 14 (12.0%) | 0.430 |
| Stomach | 10 (17.9%) | 32 (27.4%) | 0.173 |
| Duodenum | 1 (1.8%) | 11 (9.4%) | 0.106 |
| Jejunum | 1 (1.8%) | 4 (3.4%) | >.999 |
| Ileum | 13 (23.2%) | 27 (23.1%) | 0.984 |
| Colon (rectum not included) | 33 (58.9%) | 70 (59.8%) | 0.910 |
| Rectum | 14 (25.0%) | 31 (26.5%) | 0.834 |
| Endoscopic findings | |||
| EGD | N = 14 | N = 45 | |
| Ulcer | 13 (92.9%) | 37 (82.2%) | 0.671 |
| Inflammatory mucosa | 6 (42.9%) | 25 (55.6%) | 0.406 |
| Mass | 2 (14.3%) | 0 (0%) | 0.053 |
| Colonoscopy | N = 40 | N = 80 | |
| Ulcer | 33 (82.5%) | 55 (68.8%) | 0.108 |
| Inflammatory mucosa | 26 (65.0%) | 53 (66.3%) | 0.892 |
| Mass | 4 (10%) | 4 (5.0%) | 0.301 |
| Balloon-assisted enteroscopy | N = 1 | N = 2 | |
| Ulcer | 1 (100%) | 2 (100%) | |
| Inflammatory mucosa | 1 (100%) | 2 (100%) | |
| Mass | 0 (0%) | 0 (0%) | |
| Treatment and outcomes | |||
| Medications | |||
| • Ganciclovir | 36/51 (70.6%) | 105/114 (92.1%) | 0.0003 |
| • Valganclovir | 3/51 (5.9%) | 15/114 (13.2%) | 0.278 |
| • Surgery | 6/51 (11.8%) | 9/114 (7.9%) | 0.424 |
| • None | 13/51 (25.5%) | 5/114 (4.4%) | <.0001 |
| Median duration of treatment, week (range) | 3 (0–6) | 3 (0–28) | 0.003 |
| Death in 6 months | 0.047** | ||
| • in 1 month | 11/51 (21.6%) | 16/114 (14.0%) | |
| • in 6 months | 20/51 (39.2%) | 25/114 (21.9%) | |
| Mucosal healingc | |||
| • in 6 weeks | 6/9 (66.7%) | 7/20 (35%) | 0.226 |
| • at or after 6 weeks | 8/9 (88.9%) | 16/19 (67.9%) | > 0.99 |
a Ten patients had two underlying condition including 4 with glomerulonephritis undergoing renal transplantation, 3 with hematologic malignancies undergoing bone marrow transplantation, one with HIV and ITP, one with ulcerative colitis and autoimmune hemolytic anemia, and one with malignant thymoma and myasthenia gravis
blog-rank test
conly the patients who did not have underlying gastrointestinal disease