NDLI: Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis

Content Provider	Springer Nature : BioMed Central
Author	Heininger, Alexandra Haeberle, Helene Fischer, Imma Beck, Robert Riessen, Reimer Rohde, Frank Meisner, Christoph Jahn, Gerhard Koenigsrainer, Alfred Unertl, Klaus Hamprecht, Klaus
Abstract	Introduction Sepsis has been identified as a risk factor for human cytomegalovirus (CMV) reactivation in critically ill patients. However, the contribution of CMV reactivation on morbidity and mortality is still controversial. Therefore, we analyzed the incidence and impact of CMV reactivation on outcome in patients with severe sepsis. Methods In a prospective longitudinal double-blinded observational study, 97 adult nonimmunosuppressed CMV-seropositive patients with new onset of severe sepsis were included. Leukocytes, plasma and tracheal secretions were examined weekly for CMV-DNA by PCR. Tracheal secretions were additionally tested for HSV (Herpes Simplex Virus)-DNA. The influence of CMV-reactivation on the endpoints was analysed by Cox proportional-hazard regression analysis. Time-dependency was evaluated by landmark analysis. Results Six out 97 died and five were discharged from the hospital within 72 hours and were excluded of the analysis. CMV reactivation occurred in 35 of the 86 (40.69%) analysed patients. HSV infection occurred in 23 of the 35 (65.7%) CMV reactivators. In 10 patients CMV-plasma-DNAemia appeared with a DNA-content below 600 copies/ml in four cases and a peak amount of 2,830 copies/ml on average. In patients with and without CMV reactivation mortality rates were similar (37.1% vs. 35.3%, P = 0.861), respectively. However, in the multivariate COX regression analyses CMV reactivation was independently associated with increased length of stay in the ICU (30.0, interquartile range 14 to 48 vs. 12.0, interquartile range 7 to 19 days; HR (hazard ratio) 3.365; 95% CI (confidence interval) 1.233 to 9.183, P = 0.018) and in the hospital (33.0, interquartile range 24 to 62 vs. 16.0, interquartile range 10 to 24 days, HR 3.3, 95% CI 1.78 to 6.25, P < 0.001) as well as prolonged mechanical ventilation (22.0, interquartile range 6 to 36 vs. 7.5, interquartile range 5 to 15.5 days; HR 2.6,CI 95% 1.39 to 4.94; P < 0.001) and impaired pulmonary gas exchange (six days, interquartile range 1 to 17, vs. three, interquartile range 1 to 7, days in reactivators vs. non-reactivators, P = 0.038). HSV reactivation proved not to be a risk factor for these adverse effects. Conclusions These data indicate an independent correlation between CMV reactivation and increased morbidity in the well-defined group of nonimmunosuppressed patients with severe sepsis, but CMV reactivation had no impact on mortality in this group with low CMV-DNA plasma levels. Thus, the potential harms and benefits of antiviral treatment have to be weighed cautiously in patients with severe sepsis or septic shock.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc10069.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc10069
Journal	Critical Care
Issue Number	2
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2011-03-01
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Severe Sepsis Sequential Organ Failure Assessment Intensive Care Unit Stay Simplified Acute Physiology Score Intensive Care Unit Population
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients

Gastrointestinal Failure score in critically ill patients: a prospective observational study

Sex and severe sepsis

Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients

Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study

Gastrointestinal failure score in critically ill patients

Intensive insulin therapy and mortality in critically ill patients

Sequential Organ Failure Assessment score trends and sepsis survival in a Brazilian university hospital intensive care unit

Predicting a low cortisol response to adrenocorticotrophic hormone in the critically ill: a retrospective cohort study

Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis

Similar Documents

Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients

Gastrointestinal Failure score in critically ill patients: a prospective observational study

Sex and severe sepsis

Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients

Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study

Gastrointestinal failure score in critically ill patients

Intensive insulin therapy and mortality in critically ill patients

Sequential Organ Failure Assessment score trends and sepsis survival in a Brazilian university hospital intensive care unit

Predicting a low cortisol response to adrenocorticotrophic hormone in the critically ill: a retrospective cohort study

Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis