Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li, Xiaoqing Liu
{"title":"免疫力低下的重症患者中的巨细胞病毒终末器官疾病:需要关注的关键问题","authors":"Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li, Xiaoqing Liu","doi":"10.1186/s13054-024-05070-3","DOIUrl":null,"url":null,"abstract":"<p>We delved into the clinical research conducted by Sara Fernández et al. [1] with great interest. This study is a multicenter, international research initiative spanning over a decade, primarily focusing on cytomegalovirus end-organ disease (CMV-EOD) among immunosuppressed patients with critical illness. The study revealed distinctive clinical features, risk factors, and adverse clinical outcomes in immunocompromised critically ill patients with CMV-EOD, marking it as a seminal work in the field. However, there is scope for enhancing the comprehensiveness of this study with further refinements.</p><p>First, within the specific population of immunocompromised critically ill patients, certain subjects (such as those with sepsis, trauma, and other prolonged illnesses) have been overlooked and excluded. Sepsis, a significant global health concern characterized by severe response to infection that causes organ failure, leads to over 5.3 million deaths yearly, with a mortality rate of around 30% [2,3,4]. Sepsis is currently understood to induce an imbalance in the immune system (innate and adaptive), leading to phenomenon known as \"immune paralysis\" [5,6,7]. The early stages (characterized by overwhelming inflammation) and the later stages (characterized by refractory inflammation, immunosuppression, and risk of secondary infections) of sepsis are both conducive to CMV reactivation [5,6,7,8]. The incidence of CMV reactivation in septic patients seems to be similar to other common immunosuppressed patients [8]. Our team's research indicates the incidence of CMV reactivation in critically ill patients with concurrent sepsis increases by at least 30%, and sepsis is an independent risk factor for CMV reactivation [9, 10]. This aligns with other mainstream research findings, where the underlying mechanism is associated with sepsis-induced immunosuppression, promoting CMV replication [11]. Therefore, definition of immunosuppressed population in CMV-EOD research should be broadened, and more effective immune function assessment indicators are required to clearly define \"immunocompromised\", moving beyond reliance on clinical disease types for judgment.</p><p>Second, assessing the impact of CMV load levels on clinical characteristics and outcomes in CMV-EOD population is essential. Additionally, it is necessary to evaluate CMV seropositivity, both qualitatively and quantitatively, as recent studies indicate a close relationship between CMV seropositivity and poor prognosis [12]. A combined assessment of CMV load and IgG in blood may enable earlier identification of high-risk patients, allowing for antiviral treatment to improve adverse outcomes. Third, the antiviral medications used for the subjects with CMV-EOD in this study may exert a negative influence on prognosis, primarily due to bone marrow suppression leading to a decrease in immune cell levels [13]. The use of the latest anti-CMV drugs Letermovir and Maribavir may mitigate these adverse effects [14]. Finally, CMV should be recognized as a systemic infectious virus, not confined to a specific organ but widely infecting various cell types, including epithelial, endothelial, fibroblast cells, and so on [15]. Notably, CMV resides in the body as a latent infection and can reactivate under immunosuppressed conditions, leading to multi-system organ damage, particularly affecting the respiratory and digestive systems in patients with CMV-EOD. However, whether CMV is a pathogen or a bystander remains a significant and unresolved question. The prevailing view is that CMV reflects immune status and has pathogenicity, especially as reactivation is more likely with lower immune function, and the pathogenicity increases with viral load. In addition, the impact of other co-infections on prognosis needs to be clarified.</p><p>In conclusion, the study by Sara Fernández et al. describes the clinical characteristics and outcomes of immunocompromised critically ill patients with CMV-EOD, thus contributing positively to the advancement of the field. A nuanced investigation into the aforementioned matters is essential to fully elucidate the intricate interplay between CMV-EOD and poor prognosis in immunocompromised critically ill patients. Further research should delve deeper into these complexities to enhance our understanding and potentially inform more effective therapeutic strategies.</p><p>No datasets were generated or analysed during the current study.</p><dl><dt style=\"min-width:50px;\"><dfn>CMV:</dfn></dt><dd>\n<p>Cytomegalovirus</p>\n</dd><dt style=\"min-width:50px;\"><dfn>CMV-EOD:</dfn></dt><dd>\n<p>Cytomegalovirus End-Organ Disease</p>\n</dd></dl><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Fernández S, Grafia I, Peyrony O, et al. Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study. 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Clin Microbiol Infect. 2022;28(10):1335–44. https://doi.org/10.1016/j.cmi.2022.05.034.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"9.\"><p>Zhang Z, Li R, Chen Y, et al. Association between active cytomegalovirus infection and lung fibroproliferation in adult patients with acute respiratory distress syndrome: a retrospective study. BMC Infect Dis. 2022;22(1):788. https://doi.org/10.1186/s12879-022-07747-y.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"10.\"><p>Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. https://doi.org/10.1186/s12879-021-06698-0.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"11.\"><p>Marandu T, Dombek M, Cook CH. Impact of cytomegalovirus load on host response to sepsis. Med Microbiol Immunol. 2019;208(3–4):295–303. https://doi.org/10.1007/s00430-019-00603-y.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"12.\"><p>Unterberg M, Ehrentraut SF, Bracht T, et al. Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis. Crit Care. 2023;27(1):417. https://doi.org/10.1186/s13054-023-04713-1.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"13.\"><p>Cowley NJ, Owen A, Shiels SC, et al. Safety and efficacy of antiviral therapy for prevention of cytomegalovirus reactivation in immunocompetent critically ill patients: a randomized clinical trial. JAMA Intern Med. 2017;177(6):774–83. https://doi.org/10.1001/jamainternmed.2017.0895.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"14.\"><p>Razonable RR. Oral antiviral drugs for treatment of cytomegalovirus in transplant recipients. Clin Microbiol Infect. 2023;29(9):1144–9. https://doi.org/10.1016/j.cmi.2023.03.020.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"15.\"><p>Griffiths P, Reeves M. Pathogenesis of human cytomegalovirus in the immunocompromised host. Nat Rev Microbiol. 2021;19(12):759–73.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>Not applicable.</p><p>The study was funded by the National Natural Science Foundation of China (No. 82070084), Science and Technology Program of Guangzhou (Nos. SL2023A04J00179, 2024A04J3312), and Guangzhou Clinical Specialty Program (No. 2023C-TS01).</p><span>Author notes</span><ol><li><p>Yimin Li and Xiaoqing Liu have contributed equally to the study.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China</p><p>Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li & Xiaoqing Liu</p></li></ol><span>Authors</span><ol><li><span>Zhihui Zhang</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Junlu Sun</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Xuesong Liu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Rong Zhang</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yimin Li</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Xiaoqing Liu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>ZHZ wrote the manuscript; ZHZ, JLS, XSL, and RZ revised the manuscript; XQL and YML reviewed the manuscript. XQL and YML contributed equally to the study. All authors read and approved the final manuscript.</p><h3>Corresponding authors</h3><p>Correspondence to Yimin Li or Xiaoqing Liu.</p><h3>Ethical approval and consent to participate</h3>\n<p>Not applicable.</p>\n<h3>Consent for publication</h3>\n<p>Not applicable.</p>\n<h3>Competing interests</h3>\n<p>The authors declare no competing interests.</p>\n<h3>Accordance statement</h3>\n<p>Not applicable.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Zhang, Z., Sun, J., Liu, X. <i>et al.</i> Cytomegalovirus end-organ disease in immunocompromised critically ill patients: key concerns demanding attention. <i>Crit Care</i> <b>28</b>, 298 (2024). https://doi.org/10.1186/s13054-024-05070-3</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-08-15\">15 August 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-08-17\">17 August 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-09-10\">10 September 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05070-3</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\"click\" data-track-action=\"get shareable link\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\"click\" data-track-action=\"select share url\" data-track-label=\"button\"></p><button data-track=\"click\" data-track-action=\"copy share url\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cytomegalovirus end-organ disease in immunocompromised critically ill patients: key concerns demanding attention\",\"authors\":\"Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li, Xiaoqing Liu\",\"doi\":\"10.1186/s13054-024-05070-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>We delved into the clinical research conducted by Sara Fernández et al. [1] with great interest. This study is a multicenter, international research initiative spanning over a decade, primarily focusing on cytomegalovirus end-organ disease (CMV-EOD) among immunosuppressed patients with critical illness. The study revealed distinctive clinical features, risk factors, and adverse clinical outcomes in immunocompromised critically ill patients with CMV-EOD, marking it as a seminal work in the field. However, there is scope for enhancing the comprehensiveness of this study with further refinements.</p><p>First, within the specific population of immunocompromised critically ill patients, certain subjects (such as those with sepsis, trauma, and other prolonged illnesses) have been overlooked and excluded. Sepsis, a significant global health concern characterized by severe response to infection that causes organ failure, leads to over 5.3 million deaths yearly, with a mortality rate of around 30% [2,3,4]. Sepsis is currently understood to induce an imbalance in the immune system (innate and adaptive), leading to phenomenon known as \\\"immune paralysis\\\" [5,6,7]. The early stages (characterized by overwhelming inflammation) and the later stages (characterized by refractory inflammation, immunosuppression, and risk of secondary infections) of sepsis are both conducive to CMV reactivation [5,6,7,8]. The incidence of CMV reactivation in septic patients seems to be similar to other common immunosuppressed patients [8]. Our team's research indicates the incidence of CMV reactivation in critically ill patients with concurrent sepsis increases by at least 30%, and sepsis is an independent risk factor for CMV reactivation [9, 10]. This aligns with other mainstream research findings, where the underlying mechanism is associated with sepsis-induced immunosuppression, promoting CMV replication [11]. Therefore, definition of immunosuppressed population in CMV-EOD research should be broadened, and more effective immune function assessment indicators are required to clearly define \\\"immunocompromised\\\", moving beyond reliance on clinical disease types for judgment.</p><p>Second, assessing the impact of CMV load levels on clinical characteristics and outcomes in CMV-EOD population is essential. Additionally, it is necessary to evaluate CMV seropositivity, both qualitatively and quantitatively, as recent studies indicate a close relationship between CMV seropositivity and poor prognosis [12]. A combined assessment of CMV load and IgG in blood may enable earlier identification of high-risk patients, allowing for antiviral treatment to improve adverse outcomes. Third, the antiviral medications used for the subjects with CMV-EOD in this study may exert a negative influence on prognosis, primarily due to bone marrow suppression leading to a decrease in immune cell levels [13]. The use of the latest anti-CMV drugs Letermovir and Maribavir may mitigate these adverse effects [14]. Finally, CMV should be recognized as a systemic infectious virus, not confined to a specific organ but widely infecting various cell types, including epithelial, endothelial, fibroblast cells, and so on [15]. Notably, CMV resides in the body as a latent infection and can reactivate under immunosuppressed conditions, leading to multi-system organ damage, particularly affecting the respiratory and digestive systems in patients with CMV-EOD. However, whether CMV is a pathogen or a bystander remains a significant and unresolved question. The prevailing view is that CMV reflects immune status and has pathogenicity, especially as reactivation is more likely with lower immune function, and the pathogenicity increases with viral load. In addition, the impact of other co-infections on prognosis needs to be clarified.</p><p>In conclusion, the study by Sara Fernández et al. describes the clinical characteristics and outcomes of immunocompromised critically ill patients with CMV-EOD, thus contributing positively to the advancement of the field. A nuanced investigation into the aforementioned matters is essential to fully elucidate the intricate interplay between CMV-EOD and poor prognosis in immunocompromised critically ill patients. Further research should delve deeper into these complexities to enhance our understanding and potentially inform more effective therapeutic strategies.</p><p>No datasets were generated or analysed during the current study.</p><dl><dt style=\\\"min-width:50px;\\\"><dfn>CMV:</dfn></dt><dd>\\n<p>Cytomegalovirus</p>\\n</dd><dt style=\\\"min-width:50px;\\\"><dfn>CMV-EOD:</dfn></dt><dd>\\n<p>Cytomegalovirus End-Organ Disease</p>\\n</dd></dl><ol data-track-component=\\\"outbound reference\\\" data-track-context=\\\"references section\\\"><li data-counter=\\\"1.\\\"><p>Fernández S, Grafia I, Peyrony O, et al. Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study. Crit Care. 2024;28(1):243. https://doi.org/10.1186/s13054-024-05029-4.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"2.\\\"><p>Singer M, Deutschman CS, Seymour CW, et al. 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Association between active cytomegalovirus infection and lung fibroproliferation in adult patients with acute respiratory distress syndrome: a retrospective study. BMC Infect Dis. 2022;22(1):788. https://doi.org/10.1186/s12879-022-07747-y.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"10.\\\"><p>Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. https://doi.org/10.1186/s12879-021-06698-0.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"11.\\\"><p>Marandu T, Dombek M, Cook CH. Impact of cytomegalovirus load on host response to sepsis. Med Microbiol Immunol. 2019;208(3–4):295–303. https://doi.org/10.1007/s00430-019-00603-y.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\\\"12.\\\"><p>Unterberg M, Ehrentraut SF, Bracht T, et al. Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis. Crit Care. 2023;27(1):417. https://doi.org/10.1186/s13054-023-04713-1.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"13.\\\"><p>Cowley NJ, Owen A, Shiels SC, et al. Safety and efficacy of antiviral therapy for prevention of cytomegalovirus reactivation in immunocompetent critically ill patients: a randomized clinical trial. JAMA Intern Med. 2017;177(6):774–83. https://doi.org/10.1001/jamainternmed.2017.0895.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"14.\\\"><p>Razonable RR. Oral antiviral drugs for treatment of cytomegalovirus in transplant recipients. Clin Microbiol Infect. 2023;29(9):1144–9. https://doi.org/10.1016/j.cmi.2023.03.020.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\\\"15.\\\"><p>Griffiths P, Reeves M. Pathogenesis of human cytomegalovirus in the immunocompromised host. Nat Rev Microbiol. 2021;19(12):759–73.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><p>Not applicable.</p><p>The study was funded by the National Natural Science Foundation of China (No. 82070084), Science and Technology Program of Guangzhou (Nos. SL2023A04J00179, 2024A04J3312), and Guangzhou Clinical Specialty Program (No. 2023C-TS01).</p><span>Author notes</span><ol><li><p>Yimin Li and Xiaoqing Liu have contributed equally to the study.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China</p><p>Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li & Xiaoqing Liu</p></li></ol><span>Authors</span><ol><li><span>Zhihui Zhang</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Junlu Sun</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Xuesong Liu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Rong Zhang</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yimin Li</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Xiaoqing Liu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>ZHZ wrote the manuscript; ZHZ, JLS, XSL, and RZ revised the manuscript; XQL and YML reviewed the manuscript. XQL and YML contributed equally to the study. All authors read and approved the final manuscript.</p><h3>Corresponding authors</h3><p>Correspondence to Yimin Li or Xiaoqing Liu.</p><h3>Ethical approval and consent to participate</h3>\\n<p>Not applicable.</p>\\n<h3>Consent for publication</h3>\\n<p>Not applicable.</p>\\n<h3>Competing interests</h3>\\n<p>The authors declare no competing interests.</p>\\n<h3>Accordance statement</h3>\\n<p>Not applicable.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\\n<p>Reprints and permissions</p><img alt=\\\"Check for updates. 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Cytomegalovirus end-organ disease in immunocompromised critically ill patients: key concerns demanding attention. <i>Crit Care</i> <b>28</b>, 298 (2024). https://doi.org/10.1186/s13054-024-05070-3</p><p>Download citation<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><ul data-test=\\\"publication-history\\\"><li><p>Received<span>: </span><span><time datetime=\\\"2024-08-15\\\">15 August 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\\\"2024-08-17\\\">17 August 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\\\"2024-09-10\\\">10 September 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05070-3</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to 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引用次数: 0
摘要
1001/jama.2016.0287.Article PubMed PubMed Central Google Scholar Liu V, Escobar GJ, Greene JD, et al. 两个独立队列中败血症患者的住院死亡情况。JAMA.2014;312(1):90-2. https://doi.org/10.1001/jama.2014.5804.Article PubMed Google Scholar Mayr FB, Yende S, Angus DC.严重败血症的流行病学。病毒。2014;5(1):4-11. https://doi.org/10.4161/viru.27372.Article PubMed Google Scholar Hotchkiss RS, Moldawer LL, Opal SM, et al. 败血症和脓毒性休克。Nat Rev Dis Primers.2016;2:16045. https://doi.org/10.1038/nrdp.2016.45.Article PubMed PubMed Central Google Scholar Hotchkiss RS, Monneret G, Payen D. 败血症诱导的免疫抑制:从细胞功能障碍到免疫疗法。Nat Rev Immunol.2013;13(12):862-74. https://doi.org/10.1038/nri3552.Article PubMed PubMed Central Google Scholar Skirecki T, Drechsler S, Jeznach A, et al.Front Immunol.2021;12:708670. https://doi.org/10.3389/fimmu.2021.708670.Article PubMed PubMed Central Google Scholar Ong DSY, Chong GM, Chemaly RF, et al. 不同类型免疫抑制后巨细胞病毒感染的临床表现和免疫效应比较。临床微生物感染。2022;28(10):1335-44. https://doi.org/10.1016/j.cmi.2022.05.034.Article PubMed Google Scholar Zhang Z, Li R, Chen Y, et al. Active cytomegalovirus infection and lung fibroproliferation between adult patients with acute respiratory distress syndrome: a retrospective study.BMC Infect Dis.2022;22(1):788. https://doi.org/10.1186/s12879-022-07747-y.Article PubMed PubMed Central Google Scholar Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study.BMC Infect Dis.https://doi.org/10.1186/s12879-021-06698-0.Article PubMed PubMed Central Google Scholar Marandu T, Dombek M, Cook CH.巨细胞病毒载量对宿主败血症反应的影响。Med Microbiol Immunol.2019;208(3-4):295-303. https://doi.org/10.1007/s00430-019-00603-y.Article PubMed Google Scholar Unterberg M, Ehrentraut SF, Bracht T, et al. 人类巨细胞病毒血清阳性与败血症期间患者存活率降低有关。Crit Care.2023;27(1):417. https://doi.org/10.1186/s13054-023-04713-1.Article PubMed PubMed Central Google Scholar Cowley NJ, Owen A, Shiels SC, et al. 抗病毒治疗预防免疫功能正常的重症患者巨细胞病毒再激活的安全性和有效性:随机临床试验。JAMA Intern Med.2017;177(6):774-83. https://doi.org/10.1001/jamainternmed.2017.0895.Article PubMed PubMed Central Google Scholar Razonable RR.口服抗病毒药物治疗移植受者的巨细胞病毒。临床微生物感染。2023; 29(9):1144-9. https://doi.org/10.1016/j.cmi.2023.03.020.Article PubMed Google Scholar Griffiths P, Reeves M. Pathogenesis of human cytomegalovirus in the immunocompromised host.Nat Rev Microbiol.2021;19(12):759-73.Article PubMed PubMed Central Google Scholar Download referencesNot applicable.该研究得到了国家自然科学基金(编号:82070084)、广州市科技计划项目(编号:SL2023A04J00179、2024A04J3312)和广州市临床特色项目(编号:2023C-TS01)的资助。作者及工作单位广州医科大学附属第一医院呼吸疾病国家重点实验室重症医学科、国家呼吸疾病临床研究中心、国家呼吸医学中心、广州医科大学广州呼吸健康研究院Xiaoqing Liu作者:Zhihui Zhang查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者Junlu Sun查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者Xuesong Liu查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者RongZhangView author publications您也可以在PubMed Google Scholar中搜索该作者 李一民View author publications您也可以在PubMed Google Scholar中搜索该作者 刘晓庆View author publications您也可以在PubMed Google Scholar中搜索该作者ContributionsZHZ撰写了该手稿;ZHZ、JLS、XSL和RZ修改了手稿;XQL和YML审阅了手稿。XQL 和 YML 对本研究做出了同等贡献。伦理批准和参与同意书不适用。同意发表不适用。利益冲突作者声明无利益冲突。同意声明不适用。
We delved into the clinical research conducted by Sara Fernández et al. [1] with great interest. This study is a multicenter, international research initiative spanning over a decade, primarily focusing on cytomegalovirus end-organ disease (CMV-EOD) among immunosuppressed patients with critical illness. The study revealed distinctive clinical features, risk factors, and adverse clinical outcomes in immunocompromised critically ill patients with CMV-EOD, marking it as a seminal work in the field. However, there is scope for enhancing the comprehensiveness of this study with further refinements.
First, within the specific population of immunocompromised critically ill patients, certain subjects (such as those with sepsis, trauma, and other prolonged illnesses) have been overlooked and excluded. Sepsis, a significant global health concern characterized by severe response to infection that causes organ failure, leads to over 5.3 million deaths yearly, with a mortality rate of around 30% [2,3,4]. Sepsis is currently understood to induce an imbalance in the immune system (innate and adaptive), leading to phenomenon known as "immune paralysis" [5,6,7]. The early stages (characterized by overwhelming inflammation) and the later stages (characterized by refractory inflammation, immunosuppression, and risk of secondary infections) of sepsis are both conducive to CMV reactivation [5,6,7,8]. The incidence of CMV reactivation in septic patients seems to be similar to other common immunosuppressed patients [8]. Our team's research indicates the incidence of CMV reactivation in critically ill patients with concurrent sepsis increases by at least 30%, and sepsis is an independent risk factor for CMV reactivation [9, 10]. This aligns with other mainstream research findings, where the underlying mechanism is associated with sepsis-induced immunosuppression, promoting CMV replication [11]. Therefore, definition of immunosuppressed population in CMV-EOD research should be broadened, and more effective immune function assessment indicators are required to clearly define "immunocompromised", moving beyond reliance on clinical disease types for judgment.
Second, assessing the impact of CMV load levels on clinical characteristics and outcomes in CMV-EOD population is essential. Additionally, it is necessary to evaluate CMV seropositivity, both qualitatively and quantitatively, as recent studies indicate a close relationship between CMV seropositivity and poor prognosis [12]. A combined assessment of CMV load and IgG in blood may enable earlier identification of high-risk patients, allowing for antiviral treatment to improve adverse outcomes. Third, the antiviral medications used for the subjects with CMV-EOD in this study may exert a negative influence on prognosis, primarily due to bone marrow suppression leading to a decrease in immune cell levels [13]. The use of the latest anti-CMV drugs Letermovir and Maribavir may mitigate these adverse effects [14]. Finally, CMV should be recognized as a systemic infectious virus, not confined to a specific organ but widely infecting various cell types, including epithelial, endothelial, fibroblast cells, and so on [15]. Notably, CMV resides in the body as a latent infection and can reactivate under immunosuppressed conditions, leading to multi-system organ damage, particularly affecting the respiratory and digestive systems in patients with CMV-EOD. However, whether CMV is a pathogen or a bystander remains a significant and unresolved question. The prevailing view is that CMV reflects immune status and has pathogenicity, especially as reactivation is more likely with lower immune function, and the pathogenicity increases with viral load. In addition, the impact of other co-infections on prognosis needs to be clarified.
In conclusion, the study by Sara Fernández et al. describes the clinical characteristics and outcomes of immunocompromised critically ill patients with CMV-EOD, thus contributing positively to the advancement of the field. A nuanced investigation into the aforementioned matters is essential to fully elucidate the intricate interplay between CMV-EOD and poor prognosis in immunocompromised critically ill patients. Further research should delve deeper into these complexities to enhance our understanding and potentially inform more effective therapeutic strategies.
No datasets were generated or analysed during the current study.
CMV:
Cytomegalovirus
CMV-EOD:
Cytomegalovirus End-Organ Disease
Fernández S, Grafia I, Peyrony O, et al. Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study. Crit Care. 2024;28(1):243. https://doi.org/10.1186/s13054-024-05029-4.
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Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312(1):90–2. https://doi.org/10.1001/jama.2014.5804.
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Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4–11. https://doi.org/10.4161/viru.27372.
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Article PubMed PubMed Central Google Scholar
Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13(12):862–74. https://doi.org/10.1038/nri3552.
Article PubMed PubMed Central Google Scholar
Skirecki T, Drechsler S, Jeznach A, et al. An early myelosuppression in the acute mouse sepsis is partly outcome-dependent. Front Immunol. 2021;12:708670. https://doi.org/10.3389/fimmu.2021.708670.
Article PubMed PubMed Central Google Scholar
Ong DSY, Chong GM, Chemaly RF, et al. Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression. Clin Microbiol Infect. 2022;28(10):1335–44. https://doi.org/10.1016/j.cmi.2022.05.034.
Article PubMed Google Scholar
Zhang Z, Li R, Chen Y, et al. Association between active cytomegalovirus infection and lung fibroproliferation in adult patients with acute respiratory distress syndrome: a retrospective study. BMC Infect Dis. 2022;22(1):788. https://doi.org/10.1186/s12879-022-07747-y.
Article PubMed PubMed Central Google Scholar
Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. https://doi.org/10.1186/s12879-021-06698-0.
Article PubMed PubMed Central Google Scholar
Marandu T, Dombek M, Cook CH. Impact of cytomegalovirus load on host response to sepsis. Med Microbiol Immunol. 2019;208(3–4):295–303. https://doi.org/10.1007/s00430-019-00603-y.
Article PubMed Google Scholar
Unterberg M, Ehrentraut SF, Bracht T, et al. Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis. Crit Care. 2023;27(1):417. https://doi.org/10.1186/s13054-023-04713-1.
Article PubMed PubMed Central Google Scholar
Cowley NJ, Owen A, Shiels SC, et al. Safety and efficacy of antiviral therapy for prevention of cytomegalovirus reactivation in immunocompetent critically ill patients: a randomized clinical trial. JAMA Intern Med. 2017;177(6):774–83. https://doi.org/10.1001/jamainternmed.2017.0895.
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Razonable RR. Oral antiviral drugs for treatment of cytomegalovirus in transplant recipients. Clin Microbiol Infect. 2023;29(9):1144–9. https://doi.org/10.1016/j.cmi.2023.03.020.
Article PubMed Google Scholar
Griffiths P, Reeves M. Pathogenesis of human cytomegalovirus in the immunocompromised host. Nat Rev Microbiol. 2021;19(12):759–73.
Article PubMed PubMed Central Google Scholar
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The study was funded by the National Natural Science Foundation of China (No. 82070084), Science and Technology Program of Guangzhou (Nos. SL2023A04J00179, 2024A04J3312), and Guangzhou Clinical Specialty Program (No. 2023C-TS01).
Author notes
Yimin Li and Xiaoqing Liu have contributed equally to the study.
Authors and Affiliations
Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
Zhihui Zhang, Junlu Sun, Xuesong Liu, Rong Zhang, Yimin Li & Xiaoqing Liu
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Contributions
ZHZ wrote the manuscript; ZHZ, JLS, XSL, and RZ revised the manuscript; XQL and YML reviewed the manuscript. XQL and YML contributed equally to the study. All authors read and approved the final manuscript.
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Correspondence to Yimin Li or Xiaoqing Liu.
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