Prognostic significance of plasma cytomegalovirus (CMV) DNA load in immunocompetent patients with CMV pneumonia: A retrospective cohort study

IF 6.8 3区 医学 Q1 VIROLOGY
Özge Aydın Güçlü, Ezgi Demirdöğen, Esra Kazak, Nilüfer Aylin Acet Öztürk, Merve Nur Yıldız, Orkun Eray Terzi, Aslı Görek Dilektaşlı, Ahmet Ursavaş
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引用次数: 0

Abstract

Cytomegalovirus (CMV) pneumonia, often presented as pneumonitis, is characterized by respiratory failure and large interstitial infiltrates visible on chest radiographs. This retrospective cohort study investigates the predictive significance of plasma CMV DNA load on the short- and long-term mortality among immunocompetent patients diagnosed with CMV pneumonia. The study included 61 immunocompetent patients suspected of having CMV pneumonia, treated with intravenous ganciclovir after positive CMV DNA results from bronchoalveolar lavage or plasma. Our multivariate Cox regression analysis identified several independent predictors of mortality. Having idiopathic pulmonary fibrosis (IPF) significantly increased the risk of in-hospital mortality (HR: 7.27, 95% CI: 1.62–32.52, p = 0.009), as did shorter durations of antiviral therapy (HR: 0.90, 95% CI: 0.84–0.97, p = 0.005) and higher CMV DNA levels (>3870 IU/mL; HR: 9.63, 95% CI: 2.32–39.98, p = 0.002). High CMV DNA levels (>5154 IU/mL) were also predictors of 30-day mortality (HR: 9.39, 95% CI: 2.20–40.01, p = 0.002). For 1-year mortality, the presence of IPF (HR: 2.96, 95% CI: 1.08–8.06, p = 0.034), hypersensitivity pneumonia (HP) (HR: 4.30, 95% CI: 1.57–11.78, p = 0.005), shorter duration of total antiviral therapy (HR: 0.95, 95% CI: 0.93–0.99, p = 0.010), and higher CMV DNA levels (>327 IU/mL) (HR: 3.36, 95% CI: 1.33–8.47, p = 0.010) were identified as independent determinants. The study reveals that IPF increases short and long-term mortality risks, while HP increases long-term mortality. Extended antiviral treatment duration results in a 10% reduction in in-hospital mortality for each additional day of treatment. Furthermore, elevated viral loads are associated with higher mortality rates, highlighting the necessity for careful monitoring.

Abstract Image

免疫功能正常的 CMV 肺炎患者血浆巨细胞病毒 (CMV) DNA 负载的预后意义:一项回顾性队列研究
巨细胞病毒(CMV)肺炎通常表现为肺炎,其特点是呼吸衰竭和胸片可见大面积间质浸润。这项回顾性队列研究探讨了血浆 CMV DNA 负荷对确诊为 CMV 肺炎的免疫功能正常患者短期和长期死亡率的预测意义。研究纳入了 61 名疑似 CMV 肺炎的免疫功能正常患者,他们在支气管肺泡灌洗液或血浆中 CMV DNA 检测结果呈阳性后接受了静脉注射更昔洛韦治疗。我们的多变量 Cox 回归分析确定了几个独立的死亡率预测因素。特发性肺纤维化(IPF)会显著增加院内死亡风险(HR:7.27,95% CI:1.62-32.52,p = 0.009),抗病毒治疗持续时间较短(HR:0.90,95% CI:0.84-0.97,p = 0.005)和 CMV DNA 水平较高(3870 IU/mL;HR:9.63,95% CI:2.32-39.98,p = 0.002)也会增加院内死亡风险。高 CMV DNA 水平(>5154 IU/mL)也是 30 天死亡率的预测因素(HR:9.39,95% CI:2.20-40.01,p = 0.002)。就 1 年死亡率而言,存在 IPF(HR:2.96,95% CI:1.08-8.06,p = 0.034)、超敏性肺炎(HP)(HR:4.30,95% CI:1.57-11.78,p = 0.005)、总抗病毒治疗时间较短(HR:0.95,95% CI:0.93-0.99,p = 0.010)和较高的 CMV DNA 水平(>327 IU/mL)(HR:3.36,95% CI:1.33-8.47,p = 0.010)被确定为独立决定因素。研究显示,IPF 会增加短期和长期死亡风险,而 HP 会增加长期死亡率。延长抗病毒治疗时间每增加一天,院内死亡率就会降低 10%。此外,病毒载量的升高与较高的死亡率有关,这突出了仔细监测的必要性。
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来源期刊
Journal of Medical Virology
Journal of Medical Virology 医学-病毒学
CiteScore
23.20
自引率
2.40%
发文量
777
审稿时长
1 months
期刊介绍: The Journal of Medical Virology focuses on publishing original scientific papers on both basic and applied research related to viruses that affect humans. The journal publishes reports covering a wide range of topics, including the characterization, diagnosis, epidemiology, immunology, and pathogenesis of human virus infections. It also includes studies on virus morphology, genetics, replication, and interactions with host cells. The intended readership of the journal includes virologists, microbiologists, immunologists, infectious disease specialists, diagnostic laboratory technologists, epidemiologists, hematologists, and cell biologists. The Journal of Medical Virology is indexed and abstracted in various databases, including Abstracts in Anthropology (Sage), CABI, AgBiotech News & Information, National Agricultural Library, Biological Abstracts, Embase, Global Health, Web of Science, Veterinary Bulletin, and others.
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