Risk Factors for Cytomegalovirus Reactivation in Patients With Sepsis

A multivariate analysis identified specific risk factors for cytomegalovirus (CMV) reactivation among patients who were critically ill with sepsis. These findings were published in The Journal of Infectious Diseases.

Researchers from the United States and Canada pooled data from 2 prospective studies of adults with sepsis who were seropositive for CMV for this analysis. Cohort 1 (n=40) was a prospective observational study and cohort 2 (n=66) was a placebo group from a randomized, double-blind phase 2 trial studying ganciclovir prophylaxis. CMV was detected by real-time polymerase chain reaction (RT-PCR). Clinical outcomes, measured by death or continued hospitalization, ventilator-free days, intensive care unit (ICU)-free days, and hospital-free days were measured through hospital discharge for cohort 1 and through day 28 for cohort 2.

The median standardized Acute Physiology and Chronic Health Evaluation (APACHE) score for cohort 1 was 0.28 (IQR, -0.46 to 0.58) and 72.5% of patients required mechanical ventilation. The APACHE score for cohort 2 was -0.21 (IQR, -0.91 to 0.64), and 100% of patients required mechanical ventilation.

At 28 days, CMV reactivation occurred in 41% (95% CI, 32%-53%) at 0 IU/mL, 28% (95% CI, 20%-39%) at 100 IU/mL, and 18% (95% CI, 11%-28%) at 1000 IU/mL levels. A single patient had a new-onset CMV infection at day 28.

A total of 92 patients survived to day 28 and 73 patients of those were discharged prior to day 28. Patients spent a median of 13 days (IQR, 8-22) in the hospital, 8 days (IQR, 5-14) in the ICU, and 6 days (IQR, 3-11) on a ventilator. CMV reactivation was associated with hospitalization or death by day 28 (P =.021), days not in the ICU (P =.016), and days not hospitalized (P =.002). CMV reactivation greater than 100 IU/mL, greater than 1000 IU/mL, peak viral load, and area under the curve were independently associated with clinical outcomes.

Standardized APACHE scores associated with CMV reactivation were greater than 100 IU/mL (OR, 1.6; 95% CI, 1.0-2.7; P =.049). With every 1 unit increase of standardized APACHE score, a 0.2 increase of the area under the curve for CMV viral load (95% CI, 0.01-0.3; P =.04) was observed.

These findings were limited by the sample size; however, the study authors asserted this study was the largest thus far of CMV reactivation and all data were collected prospectively.

The study authors concluded these effect size estimates may identify interventional targets for patients with sepsis to avoid CMV reactivation and the associated risk for poorer clinical outcomes.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Imlay H, Dasgupta S, Boeckh M, et al. Risk factors for cytomegalovirus reactivation and association with outcomes in critically ill adults with sepsis: a pooled analysis of prospective studies. J Infect Dis. Published online November 7, 2020. doi:10.1093/infdis/jiaa697