Ganciclovir is Ineffective at Reducing Colectomy Rate in Inflammatory Bowel Disease in Patients with Superimposed Cytomegalovirus Infection
Notice bibliographique
Résumé
Purpose: Role of cytomegalovirus(CMV) infection in inflammatory bowel disease (IBD) is debated. Its discovery in refractory IBD leads to use of anti-virals despite lack of proof of efficacy. This retrospective study evaluates IBD patients to determine effect of CMV antiviral therapy on outcome. Methods: Pathological reports of patients with CMV complicating IBD over 9 years (Jan 2000 - Nov 2009) were scrutinized.CMV diagnosis was histopathological and immunostain (started in 2005;16 cases 2005-9, and 19 cases 2000-4). Admitted patient's charts (ulcerative colitis [UC] or Crohn's disease [CD]) were reviewed. Colectomies and death were compared for those on or off antiviral treatment. Demographics: age, sex, IBD subtype, site, duration, treatment (especially immunomodulators or biologics) prior to and during hospitalization, white count (x 10e9), hemoglobin (g/L) and albumin (g/L) were abstracted and tabulated. Histological intensity of CMV based on reports, was graded 1=1viral inclusion body, 2 >1-<4 inclusion bodies and 3=multiple ≥4. Colectomy and deaths were also compared in IBD patients admitted emergently during the same period. Chi squared with Fisher Exact test and unpaired student t-tests were used. All p-values were 2 tailed and significance was accepted at p ≤0.05 level. Results: 35 CMV cases were found; 13 female, 20 UC, (9/20 left sided only, 11/20 pancolitis); 15 CD[6/15 ileocolonic and 9/15 colonic), 10/35 previously on 5ASA only. 12 were treated with ganciclovir (5 mg/kg) and 23 were not. 3 colectomies (25%) and 2 deaths (5.7%) occurred in the treated group. There were 8 colectomies (CMV found post surgery, 34.8%) and no deaths in the untreated group (colectomy rates, p=0.71). No parameter reached significance. Same parameters evaluated between colectomized and non colectomized patients showed low albumin was significant (colectomized; mean ±SD, 25.9±7.8 vs. non colectomized 32.2±8.9 g/L, p=0.050). Frequency of intensity score 3 (7/10), was higher in the colectomized group ( p=0.004, Fisher test). During the same period 579 other patients (369 CD and 210 UC) were admitted. There were 64 (40 CD and 24 UC) partial or total colectomies (64/579 [11.1%] vs. 11/35 CMV+ [31.4%], p<0.001). Death rates were similar (14/557, 2.5% p=0.24, Fisher exact). Conclusion: In UC and colonic CD patients, histologically confirmed CMV, especially high intensity was associated with increased severity of disease and colectomy rates. Use of ganciclovir did not reduce rate of colectomy or death. Any true benefit to antiviral agents will likely require prospective trials. The findings support that CMV co-infection should be thoroughly ruled out in severe cases of IBD. Prognostic value of histopathology needs to be verified.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».