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Crit. Care, May 02 2025, 29 (1) 177 | https://doi.org/10.1186/s13054-025-05324-8
Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients
Joong‑Yub Kim1,2,4, Chan Mi Lee2, Yoon Hae Ahn3, Hong Yeul Lee3, Sang‑Min Lee2,3, Hyeon Jae Jo2, Pyoeng Gyun Choe2, Wan Beom Park2, Chang Kyung Kang2*, Jinwoo Lee1,2* and Nam Joong Kim2
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
3Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
4Department of Microbiology, Harvard Medical School, Boston, MA, USA.
Co-frst authors: Joong-Yub Kim and Chan Mi Lee
Co-senior authors: Chang Kyung Kang and Jinwoo Lee.
*Correspondence: Chang Kyung Kang, Jinwoo Lee
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
3Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
4Department of Microbiology, Harvard Medical School, Boston, MA, USA.
Co-frst authors: Joong-Yub Kim and Chan Mi Lee
Co-senior authors: Chang Kyung Kang and Jinwoo Lee.
*Correspondence: Chang Kyung Kang, Jinwoo Lee
Abstract
Background: The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis.
Methods: This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors.
Results: Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46-3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44-2.78), 30-day (aSHR, 2.11; 95% CI, 1.42-3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45-2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002).
Conclusion: Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.
Methods: This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors.
Results: Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46-3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44-2.78), 30-day (aSHR, 2.11; 95% CI, 1.42-3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45-2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002).
Conclusion: Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.
논문정보
- Research article
- 2025년 05월 (BRIC 등록일 2025-05-06)
- 국내(교신)+국외 연구진
- 의약학 > 감염의학
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