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Original Article
Inflammatory Bowel Diseases
High mucosal cytomegalovirus DNA helps predict adverse short-term outcome in acute severe ulcerative colitis
Saransh Jain, Divya Namdeo, Pabitra Sahu, Saurabh Kedia, Peush Sahni, Prasenjit Das, Raju Sharma, Vipin Gupta, Govind Makharia, Lalit Dar, Simon PL Travis, Vineet Ahuja
Intest Res 2021;19(4):438-447.   Published online November 6, 2020
DOI: https://doi.org/10.5217/ir.2020.00055
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.
Methods
Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.
Results
Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.
Conclusions
High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC.

Citations

Citations to this article as recorded by  
  • Epstein-Barr virus infection is an independent risk factor for surgery in patients with moderate-to-severe ulcerative colitis
    Hui Zhang, Xi Gu, Wei He, Shu-Liang Zhao, Zhi-Jun Cao
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Systematic Review: Outcome Prediction in Acute Severe Ulcerative Colitis
    Julia Angkeow, Alissa Rothman, Lara Chaaban, Nicole Paul, Joanna Melia
    Gastro Hep Advances.2024; 3(2): 260.     CrossRef
  • Predictors of adverse outcomes of steroids in patients with severe ulcerative colitis (systematic review and meta-analyses)
    A. F. Mingazov, O. I. Sushkov, B. R. Kalanov, T. A. Baranova, S. I. Achkasov
    Koloproktologia.2024; 23(1): 172.     CrossRef
  • Predicting Outcome after Acute Severe Ulcerative Colitis: A Contemporary Review and Areas for Future Research
    Sudheer Kumar Vuyyuru, Olga Maria Nardone, Vipul Jairath
    Journal of Clinical Medicine.2024; 13(15): 4509.     CrossRef
  • Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
    Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
    Indian Journal of Gastroenterology.2023; 42(3): 411.     CrossRef
  • The role of cytomegalovirus colitis on short- and long-term outcomes for patients with ulcerative colitis
    Mengmeng Zhang, Xiaoyin Bai, Huimin Zhang, Yan You, Hong Lv, Yue Li, Bei Tan, Ji Li, Hui Xu, Weiyang Zheng, Hong Yang, Jiaming Qian
    Scandinavian Journal of Gastroenterology.2022; 57(3): 282.     CrossRef
  • Cytomegalovirus in ulcerative colitis: an evidence-based approach to diagnosis and treatment
    Anuraag Jena, Shubhra Mishra, Anupam Kumar Singh, Aravind Sekar, Vishal Sharma
    Expert Review of Gastroenterology & Hepatology.2022; 16(2): 109.     CrossRef
  • Prospective validation of AIIMS index as a predictor of steroid failure in patients with acute severe ulcerative colitis
    Pabitra Sahu, Saransh Jain, Saurabh Kedia, Sudheer K. Vuyyuru, Peush Sahni, Raju Sharma, Rajesh Panwar, Prasenjit Das, Vipin Gupta, Govind Makharia, Simon Travis, Vineet Ahuja
    Indian Journal of Gastroenterology.2022; 41(3): 273.     CrossRef
  • Cytomegalovirus Infection in Patients with Inflammatory Bowel Disease
    Jun Lee
    The Korean Journal of Gastroenterology.2022; 80(2): 60.     CrossRef
  • The Impact of Human Herpesviruses in Clinical Practice of Inflammatory Bowel Disease in the Era of COVID-19
    Shuhei Hosomi, Yu Nishida, Yasuhiro Fujiwara
    Microorganisms.2021; 9(9): 1870.     CrossRef
  • Does cytomegalovirus load predict the outcome of acute severe ulcerative colitis?
    You Sun Kim
    Intestinal Research.2021; 19(4): 357.     CrossRef
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Review
Novel biomarkers for the diagnosis and prognosis of colorectal cancer
Hyung-Hoon Oh, Young-Eun Joo
Intest Res 2020;18(2):168-183.   Published online November 30, 2019
DOI: https://doi.org/10.5217/ir.2019.00080
AbstractAbstract PDFPubReaderePub
Colorectal cancer (CRC) is among the most common malignancies and remains a major cause of cancer-related death worldwide. Despite recent advances in surgical and multimodal therapies, the overall survival of advanced CRC patients remains very low. Cancer progression, including invasion and metastasis, is a major cause of death among CRC patients. The underlying mechanisms of action resulting in cancer progression are beginning to unravel. The reported molecular and biochemical mechanisms that might contribute to the phenotypic changes in favor of carcinogenesis include apoptosis inhibition, enhanced tumor cell proliferation, increased invasiveness, cell adhesion perturbations, angiogenesis promotion, and immune surveillance inhibition. These events may contribute to the development and progression of cancer. A biomarker is a molecule that can be detected in tissue, blood, or stool samples to allow the identification of pathological conditions such as cancer. Thus, it would be beneficial to identify reliable and practical molecular biomarkers that aid in the diagnostic and therapeutic processes of CRC. Recent research has targeted the development of biomarkers that aid in the early diagnosis and prognostic stratification of CRC. Despite that, the identification of diagnostic, prognostic, and/or predictive biomarkers remains challenging, and previously identified biomarkers might be insufficient to be clinically applicable or offer high patient acceptability. Here, we discuss recent advances in the development of molecular biomarkers for their potential usefulness in early and less-invasive diagnosis, treatment, and follow-up of CRC.

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