Cytomegalovirus reactivation in critically ill immunocompetent patients

被引:454
作者
Limaye, Ajit P. [1 ,2 ]
Kirby, Katharine A. [6 ]
Rubenfeld, Gordon D. [2 ]
Leisenring, Wendy M. [3 ,6 ]
Bulger, Eileen M. [4 ]
Neff, Margaret J. [2 ]
Gibran, Nicole S. [4 ]
Huang, Meei-Li [5 ]
Hayes, Tracy K. Santo [1 ]
Corey, Lawrence [2 ,5 ]
Boeckh, Michael [2 ,5 ]
机构
[1] Univ Washington, Med Ctr, Dept Lab Med, Seattle, WA 98195 USA
[2] Univ Washington, Dept Med, Seattle, WA 98195 USA
[3] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[4] Univ Washington, Dept Surg, Seattle, WA 98195 USA
[5] Fred Hutchinson Canc Res Ctr, Program Infect Dis, Seattle, WA 98104 USA
[6] Fred Hutchinson Canc Res Ctr, Program Clin Stat, Seattle, WA 98104 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2008年 / 300卷 / 04期
关键词
D O I
10.1001/jama.300.4.413
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons, but the incidence and association of CMV reactivation with adverse outcomes in critically ill persons lacking evidence of immunosuppression have not been well defined. Objective To determine the association of CMV reactivation with intensive care unit (ICU) and hospital length of stay in critically ill immunocompetent persons. Design, Setting, and Participants We prospectively assessed CMV plasma DNA-emia by thrice-weekly real-time polymerase chain reaction (PCR) and clinical outcomes in a cohort of 120 CMV-seropositive, immunocompetent adults admitted to 1 of 6 ICUs at 2 separate hospitals at a large US tertiary care academic medical center between 2004 and 2006. Clinical measurements were assessed by personnel blinded to CMV PCR results. Risk factors for CMV reactivation and association with hospital and ICU length of stay were assessed by multivariable logistic regression and proportional odds models. Main Outcome Measures Association of CMV reactivation with prolonged hospital length of stay or death. Results The primary composite end point of continued hospitalization (n=35) or death (n=10) by 30 days occurred in 45 (35%) of the 120 patients. Cytomegalovirus viremia at any level occurred in 33% (39/120; 95% confidence interval [CI], 24%-41%) at a median of 12 days (range, 3-57 days) and CMV viremia greater than 1000 copies/ mL occurred in 20% (24/120; 95% CI, 13%-28%) at a median of 26 days (range, 9-56 days). By logistic regression, CMV infection at any level (adjusted odds ratio [OR], 4.3; 95% CI, 1.6-11.9; P=.005) and at greater than 1000 copies/mL (adjusted OR, 13.9; 95% CI, 3.2-60; P < .001) and the average CMV area under the curve (AUC) in log(10) copies per milliliter (adjusted OR, 2.1; 95% CI, 1.3-3.2; P < .001) were independently associated with hospitalization or death by 30 days. In multivariable partial proportional odds models, both CMV 7-day moving average (OR, 5.1; 95% CI, 2.9-9.1; P < .001) and CMV AUC (OR, 3.2; 95% CI, 2.1-4.7; P < .001) were independently associated with a hospital length of stay of at least 14 days. Conclusions These preliminary findings suggest that reactivation of CMV occurs frequently in critically ill immunocompetent patients and is associated with prolonged hospitalization or death. A controlled trial of CMV prophylaxis in this setting is warranted.
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收藏
页码:413 / 422
页数:10
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