Cytomegalovirus reactivation in critically ill immunocompetent patients.
Cytomegalovirus reactivation in critically ill immunocompetent patients.
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DOI：
10.1001/jama.300.4.413
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发表时间：
2008-07-23
影响因子：
120.7
通讯作者：
Boeckh, Michael
中科院分区：
文献类型：
--
作者：
Limaye, Ajit P.;Kirby, Katharine A.;Rubenfeld, Gordon D.;Leisenring, Wendy M.;Bulger, Eileen M.;Neff, Margaret J.;Gibran, Nicole S.;Huang, Meei-Li;Hayes, Tracy K. Santo;Corey, Lawrence;Boeckh, Michael
巨细胞病毒(CMV)感染与免疫抑制患者的不良临床结局有关，但在缺乏免疫抑制证据(“免疫能力”)的危重患者中，CMV重新激活与不良结果的发生率和相关性尚未得到很好的界定。目的：确定重症免疫能力患者巨细胞病毒再激活与重症监护病房(ICU)和住院时间之间的关系。我们通过实时定量聚合酶链式反应每周两次前瞻性地评估了住进ICU的一组CMV血清阳性、免疫功能正常的成年人的CMV血浆DNA血症和临床结果。临床参数由对CMV聚合酶链式反应结果视而不见的人员评估。通过多变量Logistic回归和比例优势模型评估CMV重新激活的危险因素以及与住院和ICU住院时间(LOS)的关系。2004-2006年间，一家大型三级医疗学术医疗中心的两家不同医院的六个ICU。共有120名病情危重、CMV血清阳性、缺乏免疫抑制证据的成年人。巨细胞病毒再激活与住院时间延长或死亡的关系。在120名患者中，45名(35%)出现了持续住院(n=35)或在30天死亡(n=10)的主要复合终点。CMV病毒血症的发生率分别为33%(39/120，95%可信区间24%~41%)和20%(24/120，95%可信区间13%~28%)，中位数分别为12天(3~57天)和26天(9~56天)。Logistic回归分析显示，任何水平的巨细胞病毒感染(调整后OR值：4.3.[1.6-11.9]，p=0.005)、1,000拷贝/毫升(调整后OR13.9[3.2-60]，p<；0.001)或曲线下平均巨细胞病毒感染面积[auc](调整后OR2.1[1.3-3.2]，p<；0.001)与30天后住院或死亡独立相关。在多变量部分比例优势模型中，巨细胞病毒7天移动平均数(OR5.1(2.9-9.1)p<；0.0001)和巨细胞病毒AUC(OR3.2(2.1-4.7)，p<；0.0001)与医院LOS≥的14天独立相关。这些初步发现表明，巨细胞病毒的重新激活经常发生在免疫能力低下的危重患者中，并与延长住院时间或死亡有关。在这种情况下进行CMV预防的对照试验是有必要的。
Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons, but the incidence and association of CMV reactivation with adverse outcomes in persons lacking evidence of immunosuppression (“immunocompetent”) with critical illness have not been well-defined. To determine the association of CMV reactivation with intensive care unit (ICU) and hospital length of stay in critically-ill immunocompetent persons. We prospectively assessed CMV plasma DNAemia by real-time PCR twice weekly and clinical outcomes in a cohort of CMV seropositive, immunocompetent adults admitted to an ICU. Clinical parameters were assessed by personnel blinded to CMV PCR results. Risk factors for CMV reactivation and association with hospital and ICU length of stay (LOS) were assessed by multivariable logistic regression and proportional odds models. Six ICU’s at two separate hospitals at a large tertiary care academic medical center between 2004–2006. A total of 120 critically-ill, CMV seropositive adults lacking evidence of immunosuppression. Association of CMV reactivation with prolonged hospital length of stay or death. The primary composite endpoint of continued hospitalization (n=35) or death (n=10) at 30 days occurred in 45 (35%) of the 120 patients. CMV viremia at any level or > 1,000 copies/ml occurred in 33% (39 of 120, 95% confidence interval [CI] 24%–41%) and 20% (24 of 120, 95% CI 13%–28%), at a median of 12 days (range 3–57) and 26 days (range 9–56), respectively. By logistic regression, CMV infection at any level (adjusted OR: 4.3 [1.6–11.9], p = 0.005), >1,000 copies/ml (adjusted OR 13.9 [3.2–60], p < 0.001), or average CMV area under the curve [AUC] (adjusted OR 2.1 [1.3–3.2], p < 0.001), was independently associated with hospitalization or death by 30 days. In multivariable partial proportional odds models, both CMV seven-day moving average (OR 5.1 (2.9–9.1) p < 0.0001) and CMV AUC (OR 3.2 (2.1–4.7), p < 0.0001) were independently associated with a hospital LOS ≥14 days. 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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影响因子：
120.7
作者：
PITTET, D;TARARA, D;WENZEL, RP
通讯作者：
WENZEL, RP
DOI：
10.1164/ajrccm.152.1.7599829
发表时间：
1995-07-01
影响因子：
24.7
作者：
CHASTRE, J;FAGON, JY;GIBERT, C
通讯作者：
GIBERT, C
DOI：
10.1097/00005373-197403000-00001
发表时间：
1974-01-01
影响因子：
--
作者：
BAKER, SP;ONEILL, B;LONG, WB
通讯作者：
LONG, WB
影响因子：
8.8
作者：
Heininger, A;Jahn, G;Hamprecht, K
通讯作者：
Hamprecht, K
影响因子：
5.4
作者：
Cook, Charles H.;Trgovcich, Joanne;Sedmak, Daniel D.
通讯作者：
Sedmak, Daniel D.