Long-term prognosis following cytomegalovirus respiratory infection in immunocompromised and immunocompetent patients: a retrospective single-centre study.

BACKGROUND

Cytomegalovirus (CMV) respiratory infection is associated with a high mortality rate. This observational cohort study investigated the long-term survival of patients after CMV respiratory infection and risk factors affecting their prognosis.

METHODS

Overall, 569 inpatients with CMV respiratory infection enrolled in this study. The prevalence of comorbidities, clinical characteristics, 30-d, 1-year, and 5-year mortality rates, and prognostic risk factors was analysed.

RESULTS

The 30-d, 1-year, and 5-year mortality rates of CMV respiratory infection were 21.6%, 51.4%, and 69.2%, respectively. Based on the different underlying diseases, the 1- and 5-year mortality rates were higher in patients with connective tissue diseases (61.7% vs. 79.4%), post-chemoradiotherapy (56.0% vs. 85.0%), interstitial pneumonia or long-term users of glucocorticoids (55.2% vs. 75.7%), and non-immunocompromised patients (53.8% vs. 68.3%). The 30-d mortality rate had the lowest in organ transplant recipients (6.8%), whereas the 5-year mortality rate was the lowest in patients with nephrotic syndrome (38.3%). Additionally, 76% of CMV infections, 85% of Pneumocystis pneumonia infections, and 70% of Aspergillus pneumonia infections occurred within the first 6 months of glucocorticoid or immunosuppressant use. The presence of interstitial pneumonia, respiratory failure, high Pneumonia Severity Index (PSI) and CURB-65 scores, and persistent lymphocytopenia were indicative of a poor 30-d prognosis, while post-organ transplantation was associated with a favourable prognosis.

CONCLUSIONS

The mortality rate of CMV respiratory infection was found to be high, especially in patients with connective tissue diseases, cancer chemotherapy and radiation therapy, interstitial pneumonia, and non-immunocompromised patients. In patients on long-term immunosuppressants and corticosteroids, particularly within the first 6 months, vigilance needs to be exercised for CMV respiratory infection.