Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France.
Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Bégin, Saint Mandé, France.
Intensive Care Med. 2024 Mar;50(3):418-426. doi: 10.1007/s00134-024-07345-3. Epub 2024 Mar 4.
Herpesvirus reactivation has been documented among patients in the intensive care unit (ICU) and is associated with increased morbidity and mortality, particularly for cytomegalovirus (CMV). Epstein-Barr virus (EBV) has been poorly studied despite >95% of the population being seropositive. Our preliminary study suggested an association between EBV reactivation and increased morbidity and mortality. This study aimed to investigate this association among patients admitted to the ICU.
In this multicenter prospective study, polymerase chain reaction was performed to quantify EBV in patients upon ICU admission and then twice a week during their stay. Follow-up was 90 days.
The study included 129 patients; 70 (54.3%) had EBV reactivation. On day 90, there was no difference in mortality rates between patients with and without reactivation (25.7% vs 15.3%, p = 0.22). Patients with EBV reactivation at admission had increased mortality compared with those without reactivation and those with later reactivation. EBV reactivation was associated with increased morbidity. Patients with EBV reactivation had fewer ventilator-free days at day 28 than those without reactivation (18 [1-22] vs. 21 days [5-26], p = 0.037) and a higher incidence of acute respiratory distress syndrome (34.3% vs. 17%, p = 0.04), infections (92.9% vs. 78%, p = 0.03), and septic shock (58.6% vs. 32.2%, p = 0.004). More patients with EBV reactivation required renal replacement therapy (30% vs. 11.9%, p = 0.02). EBV reactivation was also associated with a more inflammatory immune profile.
While EBV reactivation was not associated with increased 90-day mortality, it was associated with significantly increased morbidity.
疱疹病毒再激活已在重症监护病房（ICU）的患者中得到证实，与发病率和死亡率增加有关，尤其是巨细胞病毒（CMV）。尽管超过 95%的人群呈 EBV 血清阳性，但 EBV 的研究仍很少。我们的初步研究表明 EBV 再激活与发病率和死亡率增加之间存在关联。本研究旨在调查 ICU 患者中这种关联。
在这项多中心前瞻性研究中，对入住 ICU 的患者进行聚合酶链反应以定量 EBV，然后在入住期间每周进行两次。随访 90 天。
该研究纳入了 129 名患者；70 名（54.3%）患者 EBV 再激活。第 90 天，再激活组和无再激活组的死亡率无差异（25.7% vs. 15.3%，p = 0.22）。入院时 EBV 再激活的患者死亡率高于无再激活患者和迟发性再激活患者。EBV 再激活与发病率增加有关。与无再激活患者相比，EBV 再激活患者在第 28 天的无呼吸机天数更少（18[1-22] vs. 21 天[5-26]，p = 0.037），急性呼吸窘迫综合征发生率更高（34.3% vs. 17%，p = 0.04），感染发生率更高（92.9% vs. 78%，p = 0.03），感染性休克发生率更高（58.6% vs. 32.2%，p = 0.004）。更多 EBV 再激活患者需要肾脏替代治疗（30% vs. 11.9%，p = 0.02）。EBV 再激活还与更具炎症性免疫特征相关。
尽管 EBV 再激活与 90 天死亡率增加无关，但与发病率显著增加有关。
