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. 2017 Feb 13;4(2):ofx029.
doi: 10.1093/ofid/ofx029. eCollection 2017 Spring.

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Philippe Lachance  1 , Justin Chen  2 , Robin Featherstone  3 , Wendy I Sligl  1   2
Affiliations

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Philippe Lachance et al. Open Forum Infect Dis. .

Abstract

Background: The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods: We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results: Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87-3.47), overall mortality (OR, 2.02; 95% CI, 1.60-2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09-10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05-4.98), need for RRT (OR, 2.37; 95% CI, 1.31-4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14-10.22). In addition, numerous sensitivity analyses were performed.

Conclusions: In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

Keywords: cytomegalovirus; immunocompetent; intensive care unit; meta-analysis; systematic review.

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Figures

Figure 1.
Figure 1.
Association between cytomegalovirus (CMV) reactivation and intensive care unit mortality. Abbreviation: CI, confidence interval.
Figure 2.
Figure 2.
Subgroup analyses for intensive care unitICU mortality
Figure 3.
Figure 3.
Association between cytomegalovirus (CMV) reactivation and overall mortality in immunocompetent critically ill patients. Abbreviation: PCR, polymerase chain reaction.
Figure 4.
Figure 4.
(A) Association between cytomegalovirus (CMV) reactivation and mechanical ventilation duration in immunocompetent critically ill patients. (B) Association between CMV reactivation and nosocomial infection in immunocompetent critically ill patients. (C) Association between CMV reactivation and need for renal replacement therapy in immunocompetent critically ill patients. (D) Association between CMV reactivation and intensive care unit length of stay in immunocompetent critically ill patients. Abbreviations: CI, confidence interval; SD, standard deviation.
See this image and copyright information in PMC

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