Prevalence and risk factors of cytomegalovirus reactivation in critically Ill patients with COVID-19 pneumonia
Issued Date
2024-05-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85193971876
Pubmed ID
38771836
Journal Title
PLoS ONE
Volume
19
Issue
5 May
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.19 No.5 May (2024)
Suggested Citation
Tassaneeyasin T., Sungkanuparph S., Srichatrapimuk S., Charoensri A., Thammavaranucupt K., Jayanama K., Kirdlarp S. Prevalence and risk factors of cytomegalovirus reactivation in critically Ill patients with COVID-19 pneumonia. PLoS ONE Vol.19 No.5 May (2024). doi:10.1371/journal.pone.0303995 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/98557
Title
Prevalence and risk factors of cytomegalovirus reactivation in critically Ill patients with COVID-19 pneumonia
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Abstract
Backgrounds In critically ill patients with COVID-19, secondary infections are potentially life-threatening complications. This study aimed to determine the prevalence, clinical characteristics, and risk factors of CMV reactivation among critically ill immunocompetent patients with COVID-19 pneumonia. Methods A retrospective cohort study was conducted among adult patients who were admitted to ICU and screened for quantitative real-time PCR for CMV viral load in a tertiary-care hospital during the third wave of the COVID-19 outbreak in Thailand. Cox regression models were used to identify significant risk factors for developing CMV reactivation. Results A total of 185 patients were studied; 133 patients (71.9%) in the non-CMV group and 52 patients (28.1%) in the CMV group. Of all, the mean age was 64.7±13.3 years and 101 patients (54.6%) were males. The CMV group had received a significantly higher median cumulative dose of corticosteroids than the non-CMV group (301 vs 177 mg of dexamethasone, p<0.001). Other modalities of treatments for COVID-19 including anti-viral drugs, anti-cytokine drugs and hemoperfusion were not different between the two groups (p>0.05). The 90-day mortality rate for all patients was 29.1%, with a significant difference between the CMV group and the non-CMV group (42.3% vs. 24.1%, p = 0.014). Median length of stay was longer in the CMV group than non-CMV group (43 vs 24 days, p<0.001). The CMV group has detectable CMV DNA load with a median [IQR] of 4,977 [1,365–14,742] IU/mL and 24,570 [3,703–106,642] in plasma and bronchoalveolar fluid, respectively. In multivariate analysis, only a cumulative corticosteroids dose of dexamethasone 250 mg (HR = 2.042; 95%CI, 1.130–3.688; p = 0.018) was associated with developing CMV reactivation. Conclusion In critically ill COVID-19 patients, CMV reactivation is frequent and a high cumulative corticosteroids dose is a significant risk factor for CMV reactivation, which is associated with poor outcomes. Further prospective studies are warranted to determine optimal management.