Ganciclovir is Ineffective at Reducing Colectomy Rate in Inflammatory Bowel Disease in Patients with Superimposed Cytomegalovirus Infection
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".