Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124, Modena, Italy.
Intensive Care Med. 2022 Jun;48(6):706-713. doi: 10.1007/s00134-022-06716-y. Epub 2022 May 18.
Cytomegalovirus (CMV) reactivation in immunocompetent critically ill patients is common and relates to a worsening outcome. In this large observational study, we evaluated the incidence and the risk factors associated with CMV reactivation and its effects on mortality in a large cohort of patients affected by coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU).
Consecutive patients with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome admitted to three ICUs from February 2020 to July 2021 were included. The patients were screened at ICU admission and once or twice per week for quantitative CMV-DNAemia in the blood. The risk factors associated with CMV blood reactivation and its association with mortality were estimated by adjusted Cox proportional hazards regression models.
CMV blood reactivation was observed in 88 patients (20.4%) of the 431 patients studied. Simplified Acute Physiology Score (SAPS) II score (HR 1031, 95% CI 1010-1053, p = 0.006), platelet count (HR 0.0996, 95% CI 0.993-0.999, p = 0.004), invasive mechanical ventilation (HR 2611, 95% CI 1223-5571, p = 0.013) and secondary bacterial infection (HR 5041; 95% CI 2852-8911, p < 0.0001) during ICU stay were related to CMV reactivation. Hospital mortality was higher in patients with (67.0%) than in patients without (24.5%) CMV reactivation but the adjusted analysis did not confirm this association (HR 1141, 95% CI 0.757-1721, p = 0.528).
The severity of illness and the occurrence of secondary bacterial infections were associated with an increased risk of CMV blood reactivation, which, however, does not seem to influence the outcome of COVID-19 ICU patients independently.
免疫功能正常的危重症患者中巨细胞病毒（CMV）再激活较为常见，与预后恶化有关。在这项大型观察性研究中，我们评估了在因 2019 年冠状病毒病（COVID-19）入住重症监护病房（ICU）的大型患者队列中，CMV 再激活的发生率及其相关因素以及对死亡率的影响。
连续纳入 2020 年 2 月至 2021 年 7 月期间从 3 个 ICU 确诊 SARS-CoV-2 感染和急性呼吸窘迫综合征的患者。在 ICU 入院时和每周筛查一次或两次患者的血液中 CMV-DNA 血症。通过调整后的 Cox 比例风险回归模型来评估与 CMV 血液再激活相关的危险因素及其与死亡率的关联。
在研究的 431 名患者中，有 88 名（20.4%）患者发生 CMV 血液再激活。简化急性生理学评分（SAPS）II 评分（HR 1031，95%CI 1010-1053，p=0.006）、血小板计数（HR 0.0996，95%CI 0.993-0.999，p=0.004）、有创机械通气（HR 2611，95%CI 1223-5571，p=0.013）和 ICU 期间继发细菌性感染（HR 5041；95%CI 2852-8911，p<0.0001）与 CMV 再激活相关。发生 CMV 再激活的患者的住院死亡率（67.0%）高于未发生 CMV 再激活的患者（24.5%），但调整分析并未证实这种关联（HR 1141，95%CI 0.757-1721，p=0.528）。
疾病严重程度和继发细菌性感染与 CMV 血液再激活的风险增加相关，但这似乎并不能独立影响 COVID-19 ICU 患者的结局。
