Schoninger Scott, Dubrovskaya Yanina, Marsh Kassandra, Altshuler Diana, Prasad Prithiv, Louie Eddie, Weisenberg Scott, Hochman Sarah, Fridman David, Trachuk Polina
Division of Internal Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Department of Pharmacy, NYU Langone Health, New York, New York, USA.
Open Forum Infect Dis. 2022 Jun 10;9(7):ofac286. doi: 10.1093/ofid/ofac286. eCollection 2022 Jul.
Patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) have poor outcomes and frequently develop comorbid conditions, including cytomegalovirus (CMV) reactivation. The implications of CMV reactivation in this setting are unknown. We aimed to investigate if treatment of CMV viremia improved in-hospital mortality in ICU patients with COVID-19.
In this single-center retrospective study, we analyzed clinical outcomes in patients diagnosed with COVID-19 pneumonia and CMV viremia admitted to an ICU from March 1, 2020, to April 30, 2021, who either received treatment (ganciclovir and/or valganciclovir) or received no treatment. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were total hospital length of stay (LOS), ICU LOS, requirement for extracorporeal membrane oxygenation (ECMO) support, duration of mechanical ventilation (MV), and predictors of in-hospital mortality.
A total of 80 patients were included, 43 patients in the treatment group and 37 in the control group. Baseline characteristics were similar in both groups. CMV-treated patients were more likely to test positive for CMV earlier in their course, more likely to be on ECMO, and received higher total steroid doses on average. In-hospital mortality was similar between the 2 groups (37.2% vs 43.2.0%; = .749). There was no significant difference in hospital LOS, though CMV-treated patients had a longer ICU LOS.
Treatment of CMV viremia did not decrease in-hospital mortality in ICU patients with COVID-19, but the sample size was limited. CMV viremia was significantly associated with total steroid dose received and longer ICU stay.
入住重症监护病房（ICU）的2019冠状病毒病（COVID-19）患者预后较差，且常出现包括巨细胞病毒（CMV）再激活在内的合并症。CMV再激活在此情况下的影响尚不清楚。我们旨在研究治疗CMV病毒血症是否能改善COVID-19的ICU患者的院内死亡率。
在这项单中心回顾性研究中，我们分析了2020年3月1日至2021年4月30日期间入住ICU的诊断为COVID-19肺炎和CMV病毒血症的患者的临床结局，这些患者要么接受了治疗（更昔洛韦和/或缬更昔洛韦），要么未接受治疗。主要结局是全因院内死亡率。次要结局包括总住院时间（LOS）、ICU住院时间、体外膜肺氧合（ECMO）支持需求、机械通气（MV）持续时间以及院内死亡率的预测因素。
共纳入80例患者，治疗组43例，对照组37例。两组的基线特征相似。接受CMV治疗的患者在病程早期更有可能CMV检测呈阳性，更有可能接受ECMO治疗，且平均接受的总类固醇剂量更高。两组的院内死亡率相似（37.2%对43.2%；P = 0.749）。住院时间无显著差异，尽管接受CMV治疗的患者ICU住院时间更长。
治疗CMV病毒血症并未降低COVID-19的ICU患者的院内死亡率，但样本量有限。CMV病毒血症与接受的总类固醇剂量和更长的ICU住院时间显著相关。
