Diagnostic value of antigenemia assay for cytomegalovirus gastrointestinal disease in immunocompromised patients

AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study.Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded.CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy.Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV.We evaluated the association between CMV-GID and patient characteristics(symptoms,underlying disease,medication,leukocyte counts,and antigenemia assay).All patients were checked with an human immunodeficiency virus(HIV)antibody test before endoscopic examination.White blood cell(WBC)counts were obtained from medical records within 1 wk of endoscopy.Leukopenia was defined as a total WBC count<5000 cells/mm 3 . For HIV patients,we also checked CD4+counts from medical records. RESULTS:A total of 99 patients were retrospectively selected for analysis.Of the immunocompromised patients,19 had malignant disease,18 had autoimmune disease,19 had disorders of biochemical homeostasis, three had undergone transplantation,and 45 had HIV infection.A total of 50 patients had received immunosuppressive therapy.No patients had inflammatory bowel disease.Fifty-five patients were diagnosed as having CMV-GID.Univariate analysis indicated an association between HIV infection,leukopenia,and positive antigenemia and CMV-GID(P<0.05).Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID(P<0.01).The sensitivity,specificity,positive predictive value,and negative predictive value of antigenemia for CMV-GID were 65.4%,93.6%, 91.9%,and 71.0%,respectively.In a subgroup analy-sis,patients with leukopenia displayed low sensitivity and high specificity.Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity.Accuracy barely differed between HIV-positive and-negative patients.In HIV-infected patients, CD4 count<50 cells/μL resulted in low sensitivity and high specificity.Differences in accuracy among patients were minor,regardless of CD4 count.In patients who had undergone both quantitative real-time polymerase chain reaction(PCR)and antigenemia assay,real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay;however,this difference was not statistically significant(P=0.312). CONCLUSION:If the antigenemia test is positive,endoscopic lesions are acceptable for the diagnosis of CMVGID without biopsy.The accuracy is not affected by HIV infection and leukopenia.Either PCR or the antigenemia assay are valid.

Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study

BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and costs.Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL.AIM To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of CAL.METHODS A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August 2019.Patients were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–CAL.Five biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also assessed.The correlation between biomarkers and CAL was evaluated.Receiver operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were estimated.RESULTS In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 d.Some operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of CAL.The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on POD4.Worsening of the clinical condition was associated with the diagnosis of CAL,presenting a higher predictive effect on POD5,with an AUROC of 0.9.WBC and ECC showed better predictive effects on POD5(AUROC=0.62 and 0.7,respectively).Those markers also presented a high NPV(94%-98%).PCT had the best predictive effect on POD5(AUROC=0.61),although it presented low accuracy.However,this biomarker revealed a high NPV on POD3,POD4,and POD5(96%,95%,and 96%,respectively).The mean CRP value on POD5 was significantly higher in the group that developed CAL compared with the group without complications(195.5±139.9 mg/L vs 59.5±43.4 mg/L;P<0.00001).On POD5,CRP had a NPV of 98%.The mean CLP value on POD3 was significantly higher in G3 compared with G1(5.26±3.58μg/mL vs 11.52±6.81μg/mL;P<0.00005).On POD3,the combination of CLP and CRP values showed a high diagnostic accuracy(AUROC=0.82),providing a 5.2 d reduction in the time to CAL diagnosis.CONCLUSION CRP and CLP are moderate predictors of CAL.However,the combination of these biomarkers presents an increased diagnostic accuracy,potentially decreasing the time to CAL diagnosis.