{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T15:22:41Z","timestamp":1785597761035,"version":"3.56.0"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Diseases"],"abstract":"<jats:p>Background\/Objectives: Cytomegalovirus (CMV) is an opportunistic pathogen, complicating acute severe ulcerative colitis (ASUC), and its role in ASUC prognosis remains a debate. This study aims to report the rates and identify predictors for colectomy at 12 months, following an episode of ASUC with concomitant CMV colonic infection. Methods: This is a retrospective cohort study of patients with ASUC and CMV colonic infection confirmed by PCR or Immunohistochemistry. Baseline clinical, biochemical, endoscopic and disease-related characteristics were recorded. Patients were followed-up for 12 months to calculate the one-year colectomy rate. Predictors of colectomy were identified via multivariate logistic regression. Results: Forty-five cases of CMV colonic infection in 37 patients with ASUC were recorded [66.7% men, mean age: 47.0 years (SD = 18.5)]. At diagnosis, 20% were on monotherapy with advanced treatment and 37.8% on advanced treatment plus corticosteroids and\/or immunomodulators. Twenty-three (51.1%) were receiving corticosteroids, while 17.8% did not receive any immunosuppressive agent. Forty (88.9%) patients were treated with ganciclovir and valganciclovir and one (2.2%) with foscarnet for at least 21 days. Eleven patients (24.4%) required colectomy, two (4.4%) during their initial hospitalization and nine (20%) during the follow-up period. The recurrence of CMV was recorded in nine (20.9%) cases, three of which required colectomy. Patients with hemoglobin &lt; 12 g\/dL (p = 0.023) and patients on vedolizumab at diagnosis (p = 0.050) had a higher probability of colectomy. Conclusions: We report a 25% one-year colectomy rate in our cohort with ASUC and superimposed CMV colonic infection. At baseline, anemia and vedolizumab treatment were associated with a higher probability of colectomy.<\/jats:p>","DOI":"10.3390\/diseases13100321","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T07:58:13Z","timestamp":1759305493000},"page":"321","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Incidence and Prognostic Factors for Colectomy in Acute Severe Ulcerative Colitis with Concomitant CMV Infection"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-5626","authenticated-orcid":false,"given":"Konstantina","family":"Kitsou","sequence":"first","affiliation":[{"name":"3rd Academic Department of Internal Medicine, GI Unit, University of Athens, Sotiria Hospital, Attica, 11527 Athens, Greece"},{"name":"National and Kapodistrian University of Athens, Attica, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Chalakatevaki","sequence":"additional","affiliation":[{"name":"3rd Academic Department of Internal Medicine, GI Unit, University of Athens, Sotiria Hospital, Attica, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Kokkotis","sequence":"additional","affiliation":[{"name":"3rd Academic Department of Internal Medicine, GI Unit, University of Athens, Sotiria Hospital, Attica, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia","family":"Papathanasiou","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Alexandra General Hospital, Attica, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassiliki","family":"Kitsou","sequence":"additional","affiliation":[{"name":"3rd Academic Department of Internal Medicine, GI Unit, University of Athens, Sotiria Hospital, Attica, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7371-8601","authenticated-orcid":false,"given":"Spyridon","family":"Michopoulos","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Alexandra General Hospital, Attica, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evanthia","family":"Zampeli","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Alexandra General Hospital, Attica, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5492-5717","authenticated-orcid":false,"given":"Giorgos","family":"Bamias","sequence":"additional","affiliation":[{"name":"3rd Academic Department of Internal Medicine, GI Unit, University of Athens, Sotiria Hospital, Attica, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1038\/s41572-020-0205-x","article-title":"Ulcerative Colitis","volume":"6","author":"Kobayashi","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5009\/gnl220017","article-title":"Acute Severe Ulcerative Colitis: Optimal Strategies for Drug Therapy","volume":"17","author":"Nakase","year":"2023","journal-title":"Gut Liver"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1002\/ueg2.12442","article-title":"Review Article: Updated Management of Acute Severe Ulcerative Colitis: From Steroids to Novel Medical Strategies","volume":"11","author":"Laharie","year":"2023","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2034","DOI":"10.1002\/rmv.2034","article-title":"Estimation of the Worldwide Seroprevalence of Cytomegalovirus: A Systematic Review and Meta-Analysis","volume":"29","author":"Zuhair","year":"2019","journal-title":"Rev. Med. Virol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Al Mana, H., Yassine, H.M., Younes, N.N., Al-Mohannadi, A., Al-Sadeq, D.W., Alhababi, D., Nasser, E.A., and Nasrallah, G.K. (2019). The Current Status of Cytomegalovirus (CMV) Prevalence in the MENA Region: A Systematic Review. Pathogens, 8.","DOI":"10.3390\/pathogens8040213"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"0300060520972880","DOI":"10.1177\/0300060520972880","article-title":"Frequent Co-Reactivation of Epstein\u2013Barr Virus in Patients with Cytomegalovirus Viremia under Immunosuppressive Therapy and\/or Chemotherapy","volume":"48","author":"Hatayama","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jentzer, A., Veyrard, P., Roblin, X., Saint-Sardos, P., Rochereau, N., Paul, S., Bourlet, T., Pozzetto, B., and Pillet, S. (2020). Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC). Microorganisms, 8.","DOI":"10.3390\/microorganisms8071078"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Qin, Y., Wang, G., Kong, D., Li, G., Wang, H., Qin, H., and Wang, H. (2021). Risk Factors of Cytomegalovirus Reactivation in Ulcerative Colitis Patients: A Meta-Analysis. Diagnostics, 11.","DOI":"10.3390\/diagnostics11111952"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1002\/ibd.21275","article-title":"Cytomegalovirus in Inflammatory Bowel Disease: Pathogen or Innocent Bystander?","volume":"16","author":"Lawlor","year":"2010","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20406223241233203","DOI":"10.1177\/20406223241233203","article-title":"Impact of Cytomegalovirus on Outcomes in Acute Severe Ulcerative Colitis: A Retrospective Observational Study","volume":"15","author":"Huang","year":"2024","journal-title":"Ther. Adv. Chronic Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5009\/gnl14450","article-title":"The Cumulative Colectomy Rate in Patients with Cytomegalovirus-Positive Ulcerative Colitis","volume":"9","author":"Ozturk","year":"2015","journal-title":"Gut Liver"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.1097\/MIB.0000000000000489","article-title":"Antiviral Therapy in Steroid-Refractory Ulcerative Colitis with Cytomegalovirus: Systematic Review and Meta-Analysis","volume":"21","author":"Shukla","year":"2015","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1093\/ecco-jcc\/jjx008","article-title":"Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-Intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-Anal Pouch Disorders","volume":"11","author":"Magro","year":"2017","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1136\/bmj.2.4884.375","article-title":"Cortisone in Ulcerative Colitis; Preliminary Report on a Therapeutic Trial","volume":"2","author":"Truelove","year":"1954","journal-title":"Br. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1093\/ecco-jcc\/jjab052","article-title":"ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease","volume":"15","author":"Kucharzik","year":"2021","journal-title":"J. Crohns Colitis"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Yokoyama, Y., Yamakawa, T., Hirano, T., Kazama, T., Hirayama, D., Wagatsuma, K., and Nakase, H. (2020). Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21072438"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.crohns.2013.12.013","article-title":"Second European Evidence-Based Consensus on the Prevention, Diagnosis and Management of Opportunistic Infections in Inflammatory Bowel Disease","volume":"8","author":"Rahier","year":"2014","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1136\/gut.2005.082909","article-title":"The Montreal Classification of Inflammatory Bowel Disease: Controversies, Consensus, and Implications","volume":"55","author":"Satsangi","year":"2006","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1002\/ibd.20520","article-title":"Use of the Noninvasive Components of the Mayo Score to Assess Clinical Response in Ulcerative Colitis","volume":"14","author":"Lewis","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/gut.43.1.29","article-title":"A Simple Clinical Colitis Activity Index","volume":"43","author":"Walmsley","year":"1998","journal-title":"Gut"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1136\/gutjnl-2011-300486","article-title":"Developing an Instrument to Assess the Endoscopic Severity of Ulcerative Colitis: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS)","volume":"61","author":"Travis","year":"2012","journal-title":"Gut"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00384-018-3210-8","article-title":"The Detection of the Cytomegalovirus DNA in the Colonic Mucosa of Patients with Ulcerative Colitis Is Associated with Increased Long-Term Risk of Proctocolectomy: Results from an Outpatient IBD Clinic","volume":"34","author":"Schenk","year":"2019","journal-title":"Int. J. Color. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"643","DOI":"10.5009\/gnl13427","article-title":"Long-Term Outcomes of Cytomegalovirus Reactivation in Patients with Moderate to Severe Ulcerative Colitis: A Multicenter Study","volume":"8","author":"Kim","year":"2014","journal-title":"Gut Liver"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.cgh.2008.05.022","article-title":"Natural History of Severe Ulcerative Colitis in a Community-Based Health Plan","volume":"6","author":"Allison","year":"2008","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/jgh.13921","article-title":"Predictors of Long-Term Outcomes in Patients with Acute Severe Colitis: A Northern Indian Cohort Study","volume":"33","author":"Jain","year":"2018","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_26","first-page":"359","article-title":"Response to First Intravenous Steroid Therapy Determines the Subsequent Risk of Colectomy in Ulcerative Colitis Patients","volume":"20","author":"Farkas","year":"2011","journal-title":"J. Gastrointestin Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1097\/MIB.0000000000000447","article-title":"Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea: The 1999-2005 Cohort","volume":"21","author":"Lee","year":"2015","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S400","DOI":"10.1093\/ecco-jcc\/jjx180.706","article-title":"P579 Risk of CMV Reactivation in UC Patients with Previous History of CMV Infection Following Infliximab or Vedolizumab Treatments","volume":"12","author":"Hommel","year":"2018","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_29","first-page":"e35473","article-title":"Cytomegalovirus Colitis in a Patient with Ulcerative Colitis on Vedolizumab Monotherapy","volume":"15","author":"Meeralam","year":"2023","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMoa1215734","article-title":"Vedolizumab as Induction and Maintenance Therapy for Ulcerative Colitis","volume":"369","author":"Feagan","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rath, T., Billmeier, U., Ferrazzi, F., Vieth, M., Ekici, A., Neurath, M.F., and Atreya, R. (2018). Effects of Anti-Integrin Treatment with Vedolizumab on Immune Pathways and Cytokines in Inflammatory Bowel Diseases. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01700"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.clim.2014.11.005","article-title":"Localization of Dendritic Cells in the Gut Epithelium Requires MAdCAM-1","volume":"156","author":"Clahsen","year":"2015","journal-title":"Clin. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1093\/ibd\/izad224","article-title":"Vedolizumab Efficacy Is Associated with Decreased Intracolonic Dendritic Cells, Not Memory T Cells","volume":"30","author":"Boden","year":"2023","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1038\/s41423-024-01186-2","article-title":"Immune Surveillance of Cytomegalovirus in Tissues","volume":"21","year":"2024","journal-title":"Cell. Mol. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/imm.12991","article-title":"The Impact of Inflationary Cytomegalovirus-specific Memory T Cells on Anti-tumour Immune Responses in Patients with Cancer","volume":"155","author":"Luo","year":"2018","journal-title":"Immunology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"621","DOI":"10.4161\/viru.22239","article-title":"Dendritic Cell Biology in Human Cytomegalovirus Infection and the Clinical Consequences for Host Immunity and Pathology","volume":"3","year":"2012","journal-title":"Virulence"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"otab082","DOI":"10.1093\/crocol\/otab082","article-title":"A Clinical Predictive Model for One-Year Colectomy in Adults Hospitalized for Severe Ulcerative Colitis","volume":"4","author":"Zafer","year":"2021","journal-title":"Crohn\u2019s Colitis 360"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1136\/gutjnl-2014-308337","article-title":"Anrukinzumab, an Anti-Interleukin 13 Monoclonal Antibody, in Active UC: Efficacy and Safety from a Phase IIa Randomised Multicentre Study","volume":"64","author":"Reinisch","year":"2015","journal-title":"Gut"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"579","DOI":"10.4291\/wjgp.v5.i4.579","article-title":"Management of Acute Severe Ulcerative Colitis","volume":"5","author":"Kedia","year":"2014","journal-title":"World J. Gastrointest. Pathophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"301","DOI":"10.4253\/wjge.v8.i6.301","article-title":"Characteristic Endoscopic Findings and Risk Factors for Cytomegalovirus-Associated Colitis in Patients with Active Ulcerative Colitis","volume":"8","author":"Hirayama","year":"2016","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1093\/ecco-jcc\/jjw071","article-title":"Cytomegalovirus Infection in Ulcerative Colitis Is Related to Severe Inflammation and a High Count of Cytomegalovirus-Positive Cells in Biopsy Is a Risk Factor for Colectomy","volume":"10","author":"Bugajski","year":"2016","journal-title":"J. Crohn\u2019s Colitis"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/10\/321\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:40:37Z","timestamp":1759308037000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/10\/321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diseases13100321"],"URL":"https:\/\/doi.org\/10.3390\/diseases13100321","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}