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Observational Study
. 2022 Jun;48(6):706-713.
doi: 10.1007/s00134-022-06716-y. Epub 2022 May 18.

Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality

Ilenia Gatto  1 , Emanuela Biagioni  1 , Irene Coloretti  1 , Carlotta Farinelli  1 , Camilla Avoni  1 , Valeria Caciagli  1 , Stefano Busani  1 , Mario Sarti  2 , Monica Pecorari  2 , William Gennari  3 , Giovanni Guaraldi  4 , Erica Franceschini  4 , Marianna Meschiari  4 , Cristina Mussini  4 , Roberto Tonelli  5 , Enrico Clini  5 , Andrea Cossarizza  6 , Massimo Girardis  7   8 ; Modena COVID-19 Working Group
Collaborators, Affiliations
Observational Study

Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality

Ilenia Gatto et al. Intensive Care Med. 2022 Jun.

Abstract

Purpose: Cytomegalovirus (CMV) reactivation in immunocompetent critically ill patients is common and relates to a worsening outcome. In this large observational study, we evaluated the incidence and the risk factors associated with CMV reactivation and its effects on mortality in a large cohort of patients affected by coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU).

Methods: Consecutive patients with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome admitted to three ICUs from February 2020 to July 2021 were included. The patients were screened at ICU admission and once or twice per week for quantitative CMV-DNAemia in the blood. The risk factors associated with CMV blood reactivation and its association with mortality were estimated by adjusted Cox proportional hazards regression models.

Results: CMV blood reactivation was observed in 88 patients (20.4%) of the 431 patients studied. Simplified Acute Physiology Score (SAPS) II score (HR 1031, 95% CI 1010-1053, p = 0.006), platelet count (HR 0.0996, 95% CI 0.993-0.999, p = 0.004), invasive mechanical ventilation (HR 2611, 95% CI 1223-5571, p = 0.013) and secondary bacterial infection (HR 5041; 95% CI 2852-8911, p < 0.0001) during ICU stay were related to CMV reactivation. Hospital mortality was higher in patients with (67.0%) than in patients without (24.5%) CMV reactivation but the adjusted analysis did not confirm this association (HR 1141, 95% CI 0.757-1721, p = 0.528).

Conclusion: The severity of illness and the occurrence of secondary bacterial infections were associated with an increased risk of CMV blood reactivation, which, however, does not seem to influence the outcome of COVID-19 ICU patients independently.

Keywords: COVID-19; Cytomegalovirus reactivation; Mechanical ventilation; Sepsis.

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Conflict of interest statement

All the authors declare non-financial interests directly or indirectly related to the work submitted for publication.

Figures

Fig. 1
Fig. 1
Association between risk factors and cytomegalovirus (CMV) blood reactivation. Hazard ratio and 95% confidential interval as obtained by adjusted Cox regression analysis; p values are also reported
See this image and copyright information in PMC

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