Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 1, February 2023, pages 1-8

Cytomegalovirus Infection Is Associated With Adverse Outcomes Among Hospitalized Pediatric Patients With Inflammatory Bowel Disease

Figure 1. Prevalence of cytomegalovirus (CMV) infection-related hospitalization among inflammatory bowel disease (IBD) patients between 2003 and 2016. IBD: inflammatory bowel disease; CMV: cytomegalovirus.

Figure 2. Prevalence of cytomegalovirus (CMV) infection among ulcerative colitis and Crohn’s disease patients between 2003 and 2016. CD: Crohn’s disease; UC: ulcerative colitis.

**Table 1.** Univariate Analysis Comparing Demographics, Associated Diseases, and Severity of Disease Between IBD Patients With and Without CMV Infection
Parameters	IBD with CMV infection	IBD without CMV infection	P value
IBD: inflammatory bowel disease; CMV: cytomegalovirus.
Age	14.92 ± 4.5	15.6 ± 3.9	< 0.001
Gender
Male	309 (45.5%)	127,643 (50.3%)	0.01
Female	370 (54.5%)	126,363 (49.7%)
Race
Caucasian	341 (50.1%)	148,564 (58.3%)	< 0.001
Black	79 (11.6%)	29,880 (11.7%)
Hispanics	99 (14.6%)	21,109 (8.3%)
Others	161 (23.7%)	55,287 (21.7%)
Insurance
Public	197 (29%)	67,000 (26.3%)	0.01
Private	411 (60.4%)	166,347 (65.3%)
Self-Pay/uninsured/others	72 (10.6%)	21,492 (8.4%)
Hospital bed size
Small	74 (11.1%)	28,435 (11.3%)	< 0.001
Medium	97 (14.5%)	59,505 (23.6%)
Large	497 (74.4%)	164,056 (65.1%)
Admission type
Elective	94 (13.9%)	50,835 (20%)	< 0.001
Nonelective	584 (86.1%)	202,882 (80%)
Primary immunodeficiency disorders	24 (3.5%)	1,640 (0.6%)	< 0.001
Human immunodeficiency virus infection	11 (1.6%)	78 (< 0.1%)	< 0.001
Malignancy	40 (5.9%)	2,265 (0.9%)	< 0.001
Transplant status	102 (15%)	2,006 (0.8%)	< 0.001
IBD surgeries	62 (9.1%)	26,906 (10.6%)	0.24
IBD severity
Low	293 (43.1%)	174,597 (68.5%)	< 0.001
Intermediate	316 (46.5%)	68,101 (26.7%)
Severe	71 (10.4%)	12,141 (4.8%)
Mortality	12 (1.8%)	335 (0.1%)	< 0.001
Length of stay	17.8 ± 1.2	5.8 ± 0.01	< 0.001
Total hospitalization charges	125,701 ± 7,239	37,405 ± 137	< 0.001

Table 1. Univariate Analysis Comparing Demographics, Associated Diseases, and Severity of Disease Between IBD Patients With and Without CMV Infection

Parameters

IBD with CMV infection

IBD without CMV infection

P value

IBD: inflammatory bowel disease; CMV: cytomegalovirus.

Age

14.92 ± 4.5

15.6 ± 3.9

< 0.001

Gender

Male

309 (45.5%)

127,643 (50.3%)

0.01

Female

370 (54.5%)

126,363 (49.7%)

Race

Caucasian

341 (50.1%)

148,564 (58.3%)

< 0.001

Black

79 (11.6%)

29,880 (11.7%)

Hispanics

99 (14.6%)

21,109 (8.3%)

Others

161 (23.7%)

55,287 (21.7%)

Insurance

Public

197 (29%)

67,000 (26.3%)

0.01

Private

411 (60.4%)

166,347 (65.3%)

Self-Pay/uninsured/others

72 (10.6%)

21,492 (8.4%)

Hospital bed size

Small

74 (11.1%)

28,435 (11.3%)

< 0.001

Medium

97 (14.5%)

59,505 (23.6%)

Large

497 (74.4%)

164,056 (65.1%)

Admission type

Elective

94 (13.9%)

50,835 (20%)

< 0.001

Nonelective

584 (86.1%)

202,882 (80%)

Primary immunodeficiency disorders

24 (3.5%)

1,640 (0.6%)

< 0.001

Human immunodeficiency virus infection

11 (1.6%)

78 (< 0.1%)

< 0.001

Malignancy

40 (5.9%)

2,265 (0.9%)

< 0.001

Transplant status

102 (15%)

2,006 (0.8%)

< 0.001

IBD surgeries

62 (9.1%)

26,906 (10.6%)

0.24

IBD severity

Low

293 (43.1%)

174,597 (68.5%)

< 0.001

Intermediate

316 (46.5%)

68,101 (26.7%)

Severe

71 (10.4%)

12,141 (4.8%)

Mortality

12 (1.8%)

335 (0.1%)

< 0.001

Length of stay

17.8 ± 1.2

5.8 ± 0.01

< 0.001

Total hospitalization charges

125,701 ± 7,239

37,405 ± 137

< 0.001

**Table 2.** Multivariate Analysis Evaluating the Impact of CMV Infection on the Outcomes of Severe Disease, Mortality, Length of Stay and Total Hospitalization Charges Among All Patients With IBD
Parameters	Adjusted odds ratio	95% CI	P value
In-hospital mortality^a	3.58	1.85 - 6.93	< 0.001
IBD severity^a
Low	Reference
Intermediate	2.48	2.11 - 2.93	< 0.001
Severe	3.31	2.54 - 4.32	< 0.001
	Average difference	95% CI	P value
Length of stay (in days)^b	9.57	9.01 - 10.14	< 0.001
Total hospitalization costs^c	$64,972	$59794 - $70,150	< 0.001
^aRefer to Supplementary Material 2 (www.gastrores.org) for a full model of multivariate logistic regression analysis. ^bRefer to Supplementary Material 3 (www.gastrores.org) for a full model of multivariate linear regression analysis. ^cRefer to Supplementary Material 4 (www.gastrores.org) for a full model of multivariate linear regression analysis. IBD: inflammatory bowel disease; CMV: cytomegalovirus; CI: confidence interval.
Length of stay (in days)^b	9.57	9.01 - 10.14	< 0.001
Total hospitalization costs^c	$64,972	$59794 - $70,150	< 0.001

Table 2. Multivariate Analysis Evaluating the Impact of CMV Infection on the Outcomes of Severe Disease, Mortality, Length of Stay and Total Hospitalization Charges Among All Patients With IBD

Parameters

Adjusted odds ratio

95% CI

P value

In-hospital mortality^a

3.58

1.85 - 6.93

< 0.001

IBD severity^a

Low

Reference

Intermediate

2.48

2.11 - 2.93

< 0.001

Severe

3.31

2.54 - 4.32

< 0.001

Average difference

95% CI

P value

Length of stay (in days)^b

9.57

9.01 - 10.14

< 0.001

Total hospitalization costs^c

$64,972

$59794 - $70,150

< 0.001

Parameters

Average difference

95% CI

P value

^aRefer to Supplementary Material 2 (www.gastrores.org) for a full model of multivariate logistic regression analysis. ^bRefer to Supplementary Material 3 (www.gastrores.org) for a full model of multivariate linear regression analysis. ^cRefer to Supplementary Material 4 (www.gastrores.org) for a full model of multivariate linear regression analysis. IBD: inflammatory bowel disease; CMV: cytomegalovirus; CI: confidence interval.

Length of stay (in days)^b

9.57

9.01 - 10.14

< 0.001

Total hospitalization costs^c

$64,972

$59794 - $70,150

< 0.001

**Table 3.** Multivariate Analysis Evaluating the Impact of CMV Infection on the Outcomes of Severe Disease, Mortality, Length of Stay and Total Hospitalization Charges Among All Patients With Ulcerative Colitis and Crohn’s Disease
Parameters	Ulcerative colitis	Crohn’s disease
IBD: inflammatory bowel disease; CMV: cytomegalovirus; CI: confidence interval.
In-hospital mortality	2.87 (1.36 - 6.06)	0.005	4.26 (1.14 - 15.86)	0.03
IBD severity
Low	Reference		Reference
Intermediate	2.27 (1.86 - 2.76)	< 0.001	2.35 (1.77 - 3.10)	P < 0.001
Severe	3.38 (2.49 - 4.60)	< 0.001	2.08 (1.20 - 3.60)	P < 0.01
	Average difference	P value	Average difference	P value
Length of stay (in days)	11.71 (10.96 - 12.45)	< 0.001	3.97 (3.04 - 4.89)	< 0.001
Total hospitalization costs	$61,304 (54,397 - 68,211)	< 0.001	$64,157 (55,499 - 72,815)	< 0.001

Table 3. Multivariate Analysis Evaluating the Impact of CMV Infection on the Outcomes of Severe Disease, Mortality, Length of Stay and Total Hospitalization Charges Among All Patients With Ulcerative Colitis and Crohn’s Disease

Parameters

Ulcerative colitis

Crohn’s disease

Adjusted odds ratio (95% CI)

P value

Adjusted odds ratio (95% CI)

P value

IBD: inflammatory bowel disease; CMV: cytomegalovirus; CI: confidence interval.

In-hospital mortality

2.87 (1.36 - 6.06)

0.005

4.26 (1.14 - 15.86)

0.03

IBD severity

Low

Reference

Intermediate

2.27 (1.86 - 2.76)

< 0.001

2.35 (1.77 - 3.10)

P < 0.001

Severe

3.38 (2.49 - 4.60)

< 0.001

2.08 (1.20 - 3.60)

P < 0.01

Average difference

P value

Average difference

P value

Length of stay (in days)

11.71 (10.96 - 12.45)

< 0.001

3.97 (3.04 - 4.89)

< 0.001

Total hospitalization costs

$61,304 (54,397 - 68,211)

< 0.001

$64,157 (55,499 - 72,815)

< 0.001