Photo Credit: Dr Microbe

The following is a summary of “Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study,” published in the July 2024 issue of Critical Care by Fernández et al.

Cytomegalovirus (CMV) infection poses high morbidity and mortality risks in patients with cellular immune deficiencies, but data on CMV end-organ disease (CMV-EOD) in patients with critical illness are limited.

Researchers conducted a retrospective study characterizing the clinical features and outcomes of CMV-EOD in patients with compromised immune systems.

They involved adults with CMV-EOD who were admitted to any of 18 ICUs in France, Israel, and Spain (January 2010 to December 2021). Patients with AIDS were excluded from the study. The data was collected based on each patient’s clinical characteristics and outcomes. A comparison of survivors and non-survivors was performed, and a multivariate analysis was performed to identify risk factors for hospital mortality.

The result showed 185 adult patients with CMV-EOD, including 80 (43.2%) with hematologic malignancies, 55 (29.7%) post-solid organ transplantation, 31 (16.8%) receiving immunosuppressants, 16 (8.6%) with solid malignancies, and 3 (1.6%) with primary immunodeficiencies. CMV pneumonia was the most common manifestation (62.2%, n=115), with a respiratory co-pathogen (47.8%, n=55), followed by CMV gastrointestinal disease (34.6%, n=64). Multiple organ involvement occurred in 8.8% (n=16) of cases. Histopathological confirmation was obtained in 8.7% (n=10/115) of patients with pneumonia and 67.2% (43/64) of gastrointestinal disease cases. Concurrent opportunistic infections were diagnosed in 37.3% (n=69) of patients. Overall hospital mortality was 61.4%, significantly higher in hematologic malignancy cases (75% vs. 51%, P= 0.001). Independent predictors of higher mortality included active graft-versus-host disease (OR 5.02; 95% CI 1.15–27.30), in hematologic malignancies, CMV pneumonia (OR 2.57; 95% CI 1.13–6.03), low lymphocyte count  < 0.30 × 10 ⁹/L  at CMV-EOD diagnosis (OR 2.40; 95% CI 1.05–5.69), higher SOFA score at ICU admission(OR 1.18; 95% CI 1.04–1.35), and older age (OR 1.04; 95% CI 1.01–1.07).

Investigators concluded that patients with critical illness and immunocompromised with CMV-EOD disease faced high mortality, influenced by underlying immunodeficiency and affected organs, with CMV pneumonia but histopathologically was rarely confirmed.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05029-4