下呼吸道巨细胞病毒再激活是危重症患者死亡的独立危险因素。

Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients.

作者信息

Kim Joong-Yub, Lee Chan Mi, Ahn Yoon Hae, Lee Hong Yeul, Lee Sang-Min, Jo Hyeon Jae, Choe Pyoeng Gyun, Park Wan Beom, Kang Chang Kyung, Lee Jinwoo, Kim Nam Joong

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

出版信息

Crit Care. 2025 May 2;29(1):177. doi: 10.1186/s13054-025-05324-8.

DOI:10.1186/s13054-025-05324-8

PMID:40317050

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12048981/

Abstract

BACKGROUND

The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis.

METHODS

This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors.

RESULTS

Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46-3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44-2.78), 30-day (aSHR, 2.11; 95% CI, 1.42-3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45-2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002).

CONCLUSION

Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.

摘要

背景

危重症患者下呼吸道（LRT）巨细胞病毒再激活的临床意义尚不清楚。我们旨在研究LRT中检测到的巨细胞病毒再激活与重症监护病房（ICU）预后之间的关联。

方法

本研究纳入了2021年1月至2023年6月期间在韩国一家三级转诊中心的医疗ICU住院的危重症患者。在入院7天内测量通过支气管镜收集的LRT样本中的巨细胞病毒载量。LRT中巨细胞病毒DNA的检测被定义为再激活。使用针对主要临床因素进行调整的多变量Fine-Gray模型评估巨细胞病毒再激活与ICU、院内、30天和90天死亡率之间的关联。

结果

在322例患者（中位年龄68岁，66.8%为男性）中，145例（45%）LRT中有巨细胞病毒再激活。巨细胞病毒再激活与ICU死亡率增加（调整后的亚分布风险比[aSHR]，2.28；95%置信区间[CI]，1.46 - 3.56）、院内死亡率增加（aSHR，2.00；95%CI，1.44 - 2.78）、30天死亡率增加（aSHR，2.11；95%CI，1.42 - 3.13）和90天死亡率增加（aSHR，2.05；95%CI，1.45 - 2.88）独立相关。抗巨细胞病毒治疗与影像学表现提示巨细胞病毒肺炎的患者ICU死亡率降低显著相关（交互作用P = 0.001），但与细菌培养阳性的患者死亡率增加相关（交互作用P = 0.002）。