Accuracy of diagnostic tests and a new algorithm for diagnosing cytomegalovirus colitis in inflammatory bowel diseases: a diagnostic study
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The optimal method for detecting CMV colitis in patients with inflammatory bowel disease (IBD) has not been established. We wanted to investigate which diagnostic test would be most accurate when defining CMV colitis rather by the further clinical course than by using another diagnostic modality.
All consecutive patients with moderately or severely active IBD who had been tested for CMV by PCR, histology, or antigenemia assay at the two campuses CBF and CCM of the Charité - Universitätsmedizin Berlin between September 2006 and September 2009 were included in this retrospective study. During that time, in patients with a positive CMV test, immunosuppressive treatment of any kind was immediately reduced and antiviral treatment was started. This allowed identifying patients who responded to antiviral treatment and those who only responded to later escalation of immunosuppressive therapy.
One hundred and nine patients were identified, out of whom nine were considered to have clinically relevant CMV colitis. Sensitivity and specificity were 1 and 0.94 for CMV PCR and 0.5 and 1 for pp65 antigen immunofluorescence assay from peripheral blood, 0.67 and 0.98 for immunohistochemistry, and 0.17 and 0.98 for hematoxylin-eosin staining. When using absence of leukocytosis, splenomegaly, and steroid refractory disease as clinical parameters to test for CMV colitis, blood CMV PCR and immunohistochemistry were able to exclude CMV colitis in negative patients with a 75% likelihood of positive patients to have clinically relevant CMV colitis.
Blood-based CMV PCR together with simple clinical parameters can exclude clinically relevant CMV colitis at a high specificity.
KeywordsInflammatory bowel diseases Ulcerative colitis Crohn’s disease Cytomegalovirus colitis Diagnostic algorithm
Compliance with ethical standards
Conflict of interest
BS received a research grant from Pfizer; served as consultant for Falk, Janssen, MSD, Abbvie, Celgene, Lilly, Takeda, Pfizer, and Hospira; and received lecture fees from Abbvie, Falk, Ferring, Janssen, MSD, Merck, and Takeda; all money went to the Charité - Universitätsmedizin Berlin, Germany. JCP served as a consultant for MSD, Pfizer, Takeda, and Biogen and received lecture fees from Vifor, Falk, Janssen, Abbvie, Pfizer, MSD, and Takeda. The other authors declare that they have no conflict of interest.
For this study, formal consent was not required.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (approval number EA4/092/09) and with the 1964 Helsinki declaration and its later amendments.
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