Cytomegalovirus reactivation in seropositive critically ill patients with liver cirrhosis: A hospital-based longitudinal study

Abstract

Background: Cytomegalovirus (CMV) reactivation is known to occur among intensive care unit (ICU) patients. CMV-reactivation is not well-evaluated among critically ill cirrhotic adults who are not overtly immunocompromised. Objectives: Primary objective was to estimate the CMV-reactivation incidence rate among seropositive/latently infected critically ill cirrhotic adults. The secondary objective was to study the risk factors, host-related cytokine responses, and ICU outcomes associated with CMV-reactivation. Methods: In this longitudinal study conducted between November 2018 and June 2019, all consecutive anti-CMV-IgG-positive cirrhotic Liver-ICU patients were assessed at day 0/ICU-admission, day 7, 14, and 21 for CMV-reactivation/plasma-DNAemia (≥500 IU/ml), cytokines, clinical, laboratory and outcome parameters. Results: Fifty-five (48 male) cirrhosis patients consecutively admitted to liver-ICU were prospectively studied. Twenty (36%) adults developed CMV-reactivation. Majority (n=17/55, 30.9%; 95% CI: 19.1 - 44.8) showed CMV- reactivation on ICU-day 7. CMV-reactivation incidence rate during 21-day follow-up was 2.75% per person-day (95% CI: 1.68-4.26% per person-day). None of the risk factors studied was independently associated with CMV-reactivation. Acute respiratory distress syndrome (p=0.04), systemic inflammatory response syndrome (p=0.01), secondary (bacterial and/or fungal) infections (p=0.009), and raised pro-inflammatory cytokines (IFN γ, p=0.012; TNFα, p=0.052) were observed concomitantly to CMV-reactivation on ICU-day 7. ICU-Mortality (n=34/55, 61.8%) did not vary with a presence or absence of CMV-reactivation (55% versus 65.7%; p=0.43). Length of stay (LOS) in liver-ICU did not differ concerning CMV-reactivation (5 days versus 4.5 days; p=0.17) Conclusions: CMV-reactivation incidence rate was considerable among seropositive non-immunosuppressed critically ill cirrhotic adults. Mortality and LOS in Liver-ICU were not significantly influenced by CMV-reactivation.

Keywords

• Cytomegalovirus
• Reactivation
• ICU
• Cirrhosis
• Real-Time PCR
• Critically ill