Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers
Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers
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DOI：
10.1016/j.jcrc.2014.10.002
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发表时间：
2015-04-01
影响因子：
3.7
通讯作者：
Dimopoulou, Ioanna
中科院分区：
文献类型：
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作者：
Frantzeskaki, Frantzeska G.;Karampi, Eirini-Sofia;Dimopoulou, Ioanna
目的：巨细胞病毒（CMV）再激活可能影响“免疫正常”血清阳性危重患者，是免疫抑制患者发病和死亡的重要原因。这项前瞻性观察性研究的目的是确定巨细胞病毒再激活在一般危重免疫功能患者中的发病率、危险因素及其与发病率和死亡率的关系。我们还研究了再激活与患者炎症反应之间的关系，炎症反应通过细胞因子水平和唾液皮质醇的应激上调来表达。方法：本研究纳入机械通气cmv血清阳性患者。在重症监护病房（ICU）入院后，每周一次，直到第28天，采用实时定量聚合酶链反应（PCR）检测巨细胞病毒血浆dna血症。巨细胞病毒再激活定义为巨细胞病毒血浆dna血症大于或等于500拷贝/mL。在ICU入院时，干扰素。测定血浆中白细胞介素（IL） 10、IL- 17a、IL-2、IL-6、肿瘤坏死因子a含量，取晨口唾液测定皮质醇含量。疾病严重程度通过急性生理和慢性健康评估II评分来评估，而器官功能障碍程度通过序贯器官衰竭评估评分来量化。记录死亡率、机械通气时间和ICU住院时间。结果：在研究期间，80例（51例男性）患者符合纳入标准，中位年龄为63岁。11例（13.75%）患者出现巨细胞病毒再激活。再活动的中位时间为ICU入院后第7天。输注红细胞总数（优势比[OR]， 1.50；置信区间[CI]， 1.06-2.13; P = 0.02）和入院时c反应蛋白水平（优势比[OR]， 1.01；置信区间[CI]， 1.00-1.02; P = 0.02）与CMV再激活独立相关。高IL-10与再激活相关（P = 0.06）。在整个28天的观察期内，CMV再激活组的序贯器官衰竭评估评分高于未再激活组（P < 0.006）。两组患者唾液皮质醇、死亡率、ICU住院时间、机械通气时间相似。结论：13.75%的危重患者发生巨细胞病毒再激活。炎症程度和输注红细胞总数构成危险因素。巨细胞病毒再激活与更严重的器官功能障碍相关，但与更差的临床结果无关。(C) 2014爱思唯尔公司版权所有。
Purpose: Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect "immunocompetent" seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol.Methods: This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon., interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor a were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded.Results: During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation (P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period (P < .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups.Conclusions: Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovirus reactivation was associated with more severe of organ dysfunction, but not with a worse clinical outcome. (C) 2014 Elsevier Inc. All rights reserved.