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Development of a Predictive Model Using Endoscopic Features for Gastric Cytomegalovirus Infection in Renal Transplant Patients

Yeo, Seong Jae, MD, PhD1; Kwon, Ki Tae, MD2; Kim, Eun Soo, MD, PhD1,3; Jung, Min Kyu, MD, PhD1; Kim, Sung Kook, MD, PhD1; Lee, Hyun Seok, MD, PhD1; Lee, Jun Seop, MD1; Lee, Sang Won, MD1; Lee, Yoo Jin, MD3; Kwak, Sang Gyu, PhD4; Han, Seungyeup, MD, PhD5

doi: 10.1097/TP.0000000000002554
Original Clinical Science—General
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Background. Cytomegalovirus (CMV) is a common viral pathogen in transplant patients which often targets the stomach. However, the endoscopic characteristics of gastric CMV infection are not well established. We aimed to develop a predictive model using endoscopic findings for gastric CMV infection in renal transplant patients.

Methods. A retrospective study of 287 kidney transplant recipients who underwent endoscopy with biopsy for suspected CMV infection from January 2006 to November 2015 at a tertiary referral hospital was performed. CMV infection was defined based on inclusion bodies in hematoxylin and eosin and immunohistochemical staining. Endoscopic and clinical parameters related to gastric CMV infection were selected by univariate analyses. Multivariate logistic regression was used to create a predictive model from β-coefficients.

Results. CMV was present in 107 (37.7%) of the 287 patients. Multivariate analysis found age (odds ratio [OR], 0.964; 95% confidence interval [CI], 0.938-0.99; P = 0.008), erosions with surface exudate (OR, 5.34; 95% CI, 2.687-10.612; P < 0.001), raised shape of erosions (OR, 3.957; 95% CI, 1.937-8.083; P < 0.001), and antral location of ulcers (OR, 15.018; 95% CI, 5.728-39.371; P < 0.001) as independent predictive factors for gastric CMV infection. Using the predictive model created from this analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71.03%, 85.56%, 74.51%, 83.24%, and 80.14%, respectively. The area under the receiver operating characteristic curve of this model for detecting CMV infection was 0.850 (95% CI, 0.803-0.889; P < 0.001).

Conclusions. The predictive model with typical endoscopic findings may be useful for detecting gastric CMV infection in renal transplant patients.

1 Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

2 Division of Infection, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

3 Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.

4 Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.

5 Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.

Received 14 August 2018. Revision received 26 October 2018.

Accepted 16 November 2018.

Y.S.J. and K.K.T. equally contributed.

S.J.Y. and K.T.K. participated in acquisition of data and drafting of the manuscript. E.S.K. participated in study concept, design, analyzing data, and critical revision of the manuscript. E.S.K. and Y.J.L participated in the review of endoscopic examinations. S.G.K participated in statistical analysis. S.K.K., H.S.L., J.S.L, M.K.J., S.W.L., Y.J.L., and S.H. participated in acquisition of data and study supervision.

The authors declare no conflicts of interest.

This research was supported by the Bisa Research Grant of Keimyung University in 2015.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Eun Soo Kim, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeuk-ro, Jung-gu, Daegu 41944, Republic of Korea. (dandy813@hanmail.net).

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