Human cytomegalovirus infections in nonimmunosuppressed critically ill patients
Human cytomegalovirus infections in nonimmunosuppressed critically ill patients
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DOI：
10.1097/00003246-200103000-00012
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发表时间：
2001-03-01
影响因子：
8.8
通讯作者：
Hamprecht, K
中科院分区：
文献类型：
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作者：
Heininger, A;Jahn, G;Hamprecht, K
目的：了解免疫功能正常的重症监护患者在大手术或外伤后活动性人巨细胞病毒（HCMV）感染和HCMV疾病的发生情况，并评价其潜在危险因素。设计：前瞻性临床研究。环境：大学医院的麻醉重症监护病房（ICU）。患者：56例无明显免疫缺陷的抗hcmv免疫球蛋白G （IgG）血清阳性患者，其简化急性生理评分（SAPS II）值在ICU住院期间≥41分。每周1次，采用聚合酶链反应法和血液及下呼吸道分泌物病毒培养法检测HCMV活动性感染；每周3次，对HCMV疾病体征进行详细的临床检查。测量结果和主要结果：56例ICU患者中，有20例（35.6%）患者符合SAPS II评分bbb40分和抗HCMV IgG血清阳性的研究标准，通过检测白细胞、血浆或呼吸道分泌物中的HCMV DNA诊断为活动性HCMV感染。在7例患者中，病毒从呼吸道分泌物中分离出来。肺炎和脑炎患者分别出现严重HCMV疾病。活动性HCMV感染患者的死亡率（55%）高于非活动性HCMV感染患者（36%）；活动性HCMV感染患者的幸存者重症监护治疗时间明显更长（中位30天vs. 23天；p = 0.0375）。对活动性HCMV感染相关因素的单因素检验显示，入院时败血症的重要性（p = 0.011）和病房或外部ICU的延长预处理（p = 0.002）；潜在恶性疾病的相关性为临界（p = 0.059），多元回归分析发现只有脓毒症与活动性HCMV感染独立相关（p = 0.02；优势比为4.62）。结论：即使在无明显免疫缺陷的ICU患者组中，抗HCMV IgG血清阳性且SAPSⅱ评分大于等于41分的患者中，也经常发生活动性HCMV感染（35.6%）。脓毒症患者的感染率是研究总人数的两倍。在20例中，2例活动性HCMV感染发展为严重HCMV疾病。正确的诊断需要特别的临床注意并结合广泛的病毒学检查。在更大的患者组中进一步的研究应该评估HCMV对ICU死亡率的影响。
Objective: To assess the occurrence of active human cytomegalovirus (HCMV) infection and HCMV disease and to evaluate potential risk factors in immunocompetent intensive care patients after major surgery or trauma.Design: A prospective clinical study.Setting: An anesthesiological intensive care unit (ICU) in a university hospital.Patients: Fifty-six anti-HCMV immunoglobulin G (IgG) seropositive patients without manifest immunodeficiency whose simplified acute physiology score (SAPS II) value rose to greater than or equal to 41 points during their ICU stay,Interventions: Once a week, the patients were examined for active HCMV infection by polymerase chain reaction and by viral cultures from blood and lower respiratory tract secretions, Three times a week, detailed clinical examination for signs of HCMV disease was carried out.Measurements and Main Results: Twenty of the 56 ICU patients (35.6%) who met the study criteria of a SAPS II score >40 points and anti-HCMV IgG seropositivity developed an active HCMV infection as diagnosed by the detection of HCMV DNA in leukocytes, plasma, or respiratory tract secretions. In seven patients, the virus was isolated in the respiratory tract secretions. Severe HCMV disease appeared in two patients with pneumonia or encephalitis respectively. In patients with active HCMV infection, the mortality tended to be higher (55%) than in those without (36%); the duration of intensive care treatment of the survivors was significantly longer in the patients with active HCMV infection (median 30 vs. 23 days; p = .0375). Univariate testing for factors associated with active HCMV infection showed the importance of sepsis at admission (p =.011) and prolonged pretreatment on the ward or in an external ICU (p = .002); the relevance of underlying malignant disease was borderline (p = .059), Multiple regression analysis identified only sepsis to be independently associated with active HCMV infection (p = .02; odds ratio, 4.62).Conclusions: Even in a group of ICU patients without manifest immunodeficit who were anti-HCMV IgG seropositive and had reached a SAPS II score of greater than or equal to 41 points, active HCMV infection occurred frequently (35.6%). Septic patients were affected twice as often as the total study population. In 2 of the 20 cases, active HCMV infection progressed to severe HCMV disease. Proper diagnosis demands special clinical attention combined with extended virological examinations. Further studies in a larger patient group should evaluate the influence of HCMV on ICU mortality.