Development and Validation of Endoscopic Prediction Model for GAstric Cytomegalovirus Infection in Patients with Renal Transplantation

Abstract

Background and aims: Cytomegalovirus (CMV) is a very common viral pathogen after organ transplant patients. However, endoscopic characteristics of gastric CMV infection have not been established. We aimed to develop and validate a prediction model using endoscopic findings for gastric CMV infection in patients with renal transplantation. Patients and methods: A retrospective study was performed in a tertiary referral hospital enrolling 354 kidney transplant recipients who received endoscopy with biopsy for suspected CMV infection from Jan. 2005 to Nov. 2015. For the development phase, endoscopic parameters were selected by univariate logistic regression analyses. Then, the prediction model was established on the basis of b coefficients of the multivariate logistic regression. For the validation of the model, the same regression equation was tested on the other group. Results: Age, days from renal transplantation to endoscopic biopsy, erosion at antrum, erosion with exudate, raised erosion, and ulcer at antrum were selected as the predicting factors for gastric CMV infection. In the development set (n=176) using these five markers, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 92.23, 80.82, 87.16, and 88.06, respectively. In the validation set (n=178), the sensitivity, specificity, PPV, and NPV were 83.87, 82.35, 83.87 and 82.35, respectively. Conclusion: This endoscopic prediction model using 6 risk factors can be a reliable diagnostic tool for gastric CMV infection after renal transplantation.