Utility of cytomegalovirus (CMV) qualitative polymerase chain reaction from gastrointestinal biopsies in diagnosis of CMV gastrointestinal disease: A 10-year retrospective study.

IF 3.4 3区医学 Q2 VIROLOGY

Journal of Clinical Virology Pub Date : 2025-10-09 DOI:10.1016/j.jcv.2025.105879

Cole Schonhofer, Calvin Ka-Fung Lo, Daniel R Owen, Khuloud Aldhaheri, Nancy Matic, Christopher F Lowe, David F Schaeffer, Sara Belga, Alissa Wright

{"title":"Utility of cytomegalovirus (CMV) qualitative polymerase chain reaction from gastrointestinal biopsies in diagnosis of CMV gastrointestinal disease: A 10-year retrospective study.","authors":"Cole Schonhofer, Calvin Ka-Fung Lo, Daniel R Owen, Khuloud Aldhaheri, Nancy Matic, Christopher F Lowe, David F Schaeffer, Sara Belga, Alissa Wright","doi":"10.1016/j.jcv.2025.105879","DOIUrl":null,"url":null,"abstract":"Background: Cytomegalovirus (CMV) gastrointestinal (GI) disease is traditionally diagnosed via histopathology of endoscopic tissue biopsies. The utility of tissue PCR for predicting CMV GI disease remains unclear. We conducted a 10-year retrospective single-center study comparing tissue PCR performance to histopathology for the diagnosis of CMV GI disease.Methods: Adult patients with GI tissue biopsy between February 2014 and January 2024 were included. Qualitative tissue PCR was compared to histopathology (gold standard) to determine sensitivity, specificity, and receiver operating characteristic (ROC) curves. Log-binomial regression models were performed to evaluate potential predictors of CMV GI disease.Results: Our study comprised 533 patients with 635 endoscopies. Underlying diagnoses included solid organ transplant, hematopoietic stem cell transplantation (HSCT), inflammatory bowel disease, and others. Histopathologic evidence of CMV disease was found in 41/635 biopsies and in 37/533 patients. Compared to histopathology, tissue PCR sensitivity was 100 % (95 % CI 91.4-100 %), and specificity was 71.7 % (67.9-75.3 %). Area under ROC curve (AUC) was 0.86 (0.84-0.88). Exclusion of specimens with cycle threshold >32 increased specificity to 82.7 % (79.4-85.6 %) but at the cost of decreased sensitivity (87.8 %, 73.8-95.9 %). Multivariable analyses demonstrated that plasma CMV DNAemia >1000 IU/mL increased risk of GI disease (risk ratio 10.9, 95 % CI 5.32-22.49) while HSCT was negatively associated (risk ratio 0.18, 95 % 0.05-0.78).Conclusion: CMV tissue PCR correctly identified CMV GI disease in 100 % of histology-proven cases. Specificity was poor, likely reflecting detection of viral shedding. Overall, our study suggests that CMV tissue PCR should be reserved to rule out CMV GI disease in high pre-test probability settings (e.g. patients with known risk factors and compatible symptoms).","PeriodicalId":15517,"journal":{"name":"Journal of Clinical Virology","volume":"181 ","pages":"105879"},"PeriodicalIF":3.4000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Virology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jcv.2025.105879","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"VIROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Cytomegalovirus (CMV) gastrointestinal (GI) disease is traditionally diagnosed via histopathology of endoscopic tissue biopsies. The utility of tissue PCR for predicting CMV GI disease remains unclear. We conducted a 10-year retrospective single-center study comparing tissue PCR performance to histopathology for the diagnosis of CMV GI disease.

Methods: Adult patients with GI tissue biopsy between February 2014 and January 2024 were included. Qualitative tissue PCR was compared to histopathology (gold standard) to determine sensitivity, specificity, and receiver operating characteristic (ROC) curves. Log-binomial regression models were performed to evaluate potential predictors of CMV GI disease.

Results: Our study comprised 533 patients with 635 endoscopies. Underlying diagnoses included solid organ transplant, hematopoietic stem cell transplantation (HSCT), inflammatory bowel disease, and others. Histopathologic evidence of CMV disease was found in 41/635 biopsies and in 37/533 patients. Compared to histopathology, tissue PCR sensitivity was 100 % (95 % CI 91.4-100 %), and specificity was 71.7 % (67.9-75.3 %). Area under ROC curve (AUC) was 0.86 (0.84-0.88). Exclusion of specimens with cycle threshold >32 increased specificity to 82.7 % (79.4-85.6 %) but at the cost of decreased sensitivity (87.8 %, 73.8-95.9 %). Multivariable analyses demonstrated that plasma CMV DNAemia >1000 IU/mL increased risk of GI disease (risk ratio 10.9, 95 % CI 5.32-22.49) while HSCT was negatively associated (risk ratio 0.18, 95 % 0.05-0.78).

Conclusion: CMV tissue PCR correctly identified CMV GI disease in 100 % of histology-proven cases. Specificity was poor, likely reflecting detection of viral shedding. Overall, our study suggests that CMV tissue PCR should be reserved to rule out CMV GI disease in high pre-test probability settings (e.g. patients with known risk factors and compatible symptoms).

查看原文本刊更多论文

胃肠道活检巨细胞病毒（CMV）定性聚合酶链反应在巨细胞病毒胃肠道疾病诊断中的应用：一项10年回顾性研究

背景：巨细胞病毒（CMV）胃肠道（GI）疾病传统上是通过内镜组织活检的组织病理学诊断的。组织PCR预测CMV胃肠道疾病的效用尚不清楚。我们进行了一项为期10年的回顾性单中心研究，比较了组织PCR表现和组织病理学诊断巨细胞病毒胃肠道疾病的效果。方法：纳入2014年2月至2024年1月行胃肠组织活检的成年患者。将定性组织PCR与组织病理学（金标准）进行比较，以确定灵敏度、特异性和受试者工作特征（ROC）曲线。采用对数-二项回归模型评估CMV胃肠道疾病的潜在预测因素。结果：我们的研究包括533例患者，635例内窥镜检查。潜在的诊断包括实体器官移植、造血干细胞移植（HSCT）、炎症性肠病等。635例活检中有41例和533例患者中有37例发现巨细胞病毒疾病的组织病理学证据。与组织病理学比较，组织PCR敏感性为100 %(95 % CI 91.4 ~ 100 %)，特异性为71.7 %（67.9 ~ 75.3 %）。ROC曲线下面积（AUC）为0.86（0.84 ~ 0.88）。排除周期阈值bbb32的标本可将特异性提高至82.7 %(77.4 -85.6 %)，但代价是敏感性降低（87.8 %,73.8-95.9 %）。多变量分析表明，血浆CMV DNAemia >1000 IU/mL增加了胃肠道疾病的风险（风险比10.9,95 % CI 5.32-22.49），而HSCT呈负相关（风险比0.18,95 % 0.05-0.78）。结论：CMV组织PCR在100% %组织学证实的CMV胃肠道疾病中正确诊断。特异性较差，可能反映了病毒脱落的检测。总的来说，我们的研究表明，在检测前概率较高的情况下（例如，已知危险因素和相容症状的患者），应该保留CMV组织PCR来排除CMV胃肠道疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Virology 医学-病毒学

CiteScore

22.70

自引率

1.10%

发文量

149

审稿时长

24 days

期刊介绍： The Journal of Clinical Virology, an esteemed international publication, serves as the official journal for both the Pan American Society for Clinical Virology and The European Society for Clinical Virology. Dedicated to advancing the understanding of human virology in clinical settings, the Journal of Clinical Virology focuses on disseminating research papers and reviews pertaining to the clinical aspects of virology. Its scope encompasses articles discussing diagnostic methodologies and virus-induced clinical conditions, with an emphasis on practicality and relevance to clinical practice. The journal publishes on topics that include: • new diagnostic technologies • nucleic acid amplification and serologic testing • targeted and metagenomic next-generation sequencing • emerging pandemic viral threats • respiratory viruses • transplant viruses • chronic viral infections • cancer-associated viruses • gastrointestinal viruses • central nervous system viruses • one health (excludes animal health)