Lee Kyoung Yong, Yoo Byung-Woo, Ahn Sung Soo, Bae William Han, Lee Hyukmin, Jung Seung Min, Lee Sang-Won, Park Yong-Beom, Song Jason Jungsik
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea.
PLoS One. 2017 Jul 25;12(7):e0181590. doi: 10.1371/journal.pone.0181590. eCollection 2017.
Cytomegaloviruses (CMV) can have a significant impact on the prognosis of immunocompromised patients. Unlike in the transplantation and AIDS fields, only a few studies on CMV infections have been published in the field of autoimmunity. In this study, we examined the clinical outcomes of CMV infections in patients with autoimmune diseases at a single tertiary medical institution.
A retrospective study was performed to identify the mortality risk factors associated with CMV infections in patients with autoimmune diseases. We reviewed the medical records of patients with autoimmune diseases who were diagnosed with CMV infections using real-time quantitative polymerase chain reaction between December 2005 and March 2016. Clinical and laboratory parameters as well as treatment outcomes were analyzed.
Seventy-three CMV infected patients were separated into survivors and non-survivors. Non-survivors had significantly higher median CMV-DNA copy numbers than survivors (95,500 vs 6,700 copies/mL, p = 0.005) and demonstrated significantly more frequent incidents of CMV pneumonitis (69.2 vs 36.2%, p = 0.007). After adjusting for multiple confounding covariates, the log CMV-DNA copies/mL (hazard ratio, 1.48; 95% confidence interval, 1.14-1.92; p = 0.003) and the presence of concurrent infections (hazard ratio, 22.00; 95% confidence interval, 2.75-175.97, p = 0.004) were identified as independent mortality risk factors. Furthermore, patients with high CMV copy numbers (> 60,000 copies/mL) had higher in-hospital mortality than those with low CMV copy numbers (p < 0.05).
CMV-DNA copy numbers and concurrent infections are predictors of in-hospital mortality in CMV-infected patients with autoimmune diseases. Therefore, serial measurements of CMV-DNA copy numbers and close observation for signs of other infections are recommended for patients with autoimmune diseases who have concurrent CMV infection.
巨细胞病毒（CMV）可对免疫功能低下患者的预后产生重大影响。与移植和艾滋病领域不同，自身免疫领域中关于CMV感染的研究仅有少数发表。在本研究中，我们在一家三级医疗机构中研究了自身免疫性疾病患者CMV感染的临床结局。
进行一项回顾性研究，以确定自身免疫性疾病患者中与CMV感染相关的死亡风险因素。我们回顾了2005年12月至2016年3月期间使用实时定量聚合酶链反应诊断为CMV感染的自身免疫性疾病患者的病历。分析了临床和实验室参数以及治疗结果。
73例CMV感染患者被分为存活者和非存活者。非存活者的CMV-DNA拷贝数中位数显著高于存活者（95,500对6,700拷贝/毫升，p = 0.005），且CMV肺炎的发生率显著更高（69.2%对36.2%，p = 0.007）。在对多个混杂协变量进行调整后，CMV-DNA拷贝数/毫升的对数（风险比，1.48；95%置信区间，1.14 - 1.92；p = 0.003）和并发感染的存在（风险比，22.00；95%置信区间，2.75 - 175.97，p = 0.004）被确定为独立的死亡风险因素。此外，CMV拷贝数高（> 60,000拷贝/毫升）的患者住院死亡率高于CMV拷贝数低的患者（p < 0.05）。
CMV-DNA拷贝数和并发感染是自身免疫性疾病CMV感染患者住院死亡的预测因素。因此，对于并发CMV感染的自身免疫性疾病患者，建议连续测量CMV-DNA拷贝数并密切观察其他感染迹象。
