State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University (Guangzhou Medical University), Guangzhou, China.
Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
BMC Infect Dis. 2018 Jun 28;18(1):289. doi: 10.1186/s12879-018-3195-5.
Cytomegalovirus (CMV) infection is common in immunocompetent patients in intensive care units (ICUs). However, whether CMV infection or CMV reactivation contributes to mortality of immunocompetent patients remains unclear.
A literature search was conducted for relevant studies published before May 30, 2016. Studies reporting on CMV infection in immunocompetent patients in ICUs and containing 2 × 2 tables on CMV results and all-cause mortality were included.
Eighteen studies involving 2398 immunocompetent patients admitted to ICUs were included in the meta-analysis. The overall rate of CMV infection was 27% (95%CI 22-34%, I = 89%, n = 2398) and the CMV reactivation was 31% (95%CI 24-39%, I = 74%, n = 666). The odds ratio (OR) for all-cause mortality among patients with CMV infection, compared with those without infection, was 2.16 (95%CI 1.70-2.74, I = 10%, n = 2239). Moreover, upon exclusion of studies in which antiviral treatment was possibly or definitely provided to some patients, the association of mortality rate with CMV infection was also statistically significant (OR: 1.69, 95%CI 1.01-2.83, I = 37%, n = 912,). For CMV seropositive patients, the OR for mortality in patients with CMV reactivation as compared with patients without CMV reactivation was 1.72 (95%CI 1.04-2.85, I = 29%, n = 664). Patients with CMV infection required significantly longer mechanical ventilation (mean difference (MD): 9 days (95% CI 5-14, I = 81%, n = 875)) and longer duration of ICU stay (MD: 12 days (95% CI 7-17, I = 70%, n = 949)) than patients without CMV infection. When analysis was limited to detection in blood, CMV infection without antiviral drug treatment or reactivation was not significantly associated with higher mortality (OR: 1.69, 95%CI 0.81-3.54, I = 52%, n = 722; OR: 1.49, I = 63%, n = 469).
Critically ill patients without immunosuppression admitted to ICUs show a high rate of CMV infection. CMV infection during the natural unaltered course or reactivation in critically ill patients is associated with increased mortality, but have no effect on mortality when CMV in blood. More studies are needed to clarify the impact of CMV infection on clinical outcomes in those patients.
巨细胞病毒（CMV）感染在重症监护病房（ICU）中的免疫功能正常的患者中很常见。然而，CMV 感染或 CMV 再激活是否导致免疫功能正常患者的死亡率增加仍不清楚。
对截至 2016 年 5 月 30 日之前发表的相关研究进行了文献检索。纳入了报道 ICU 中免疫功能正常患者 CMV 感染并包含 CMV 结果和全因死亡率 2×2 表的研究。
18 项纳入了 2398 例 ICU 中免疫功能正常患者的研究被纳入荟萃分析。CMV 感染的总体发生率为 27%（95%CI 22-34%，I=89%，n=2398），CMV 再激活率为 31%（95%CI 24-39%，I=74%，n=666）。与未感染患者相比，CMV 感染患者的全因死亡率的比值比（OR）为 2.16（95%CI 1.70-2.74，I=10%，n=2239）。此外，在排除了可能或肯定对某些患者进行抗病毒治疗的研究后，死亡率与 CMV 感染的相关性仍然具有统计学意义（OR：1.69，95%CI 1.01-2.83，I=37%，n=912）。对于 CMV 血清阳性患者，与无 CMV 再激活患者相比，CMV 再激活患者的死亡率的比值比为 1.72（95%CI 1.04-2.85，I=29%，n=664）。CMV 感染患者需要接受机械通气的时间明显延长（平均差异（MD）：9 天（95%CI 5-14，I=81%，n=875））和 ICU 住院时间延长（MD：12 天（95%CI 7-17，I=70%，n=949）），与未感染 CMV 的患者相比。当分析仅限于血液检测时，未接受抗病毒药物治疗或再激活的 CMV 感染与死亡率升高无显著相关性（OR：1.69，95%CI 0.81-3.54，I=52%，n=722；OR：1.49，I=63%，n=469）。
入住 ICU 的无免疫抑制的危重症患者 CMV 感染率较高。在危重症患者中，CMV 感染在自然未经干预的过程中或再激活与死亡率增加相关，但在血液中检测到 CMV 时对死亡率无影响。需要进一步的研究来阐明 CMV 感染对这些患者临床结局的影响。
