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Outcomes of Cytomegalovirus Viremia Treatment in Critically Ill Patients With COVID-19 Infection
Scott Schoninger1, Yanina Dubrovskaya2, Kassandra Marsh2
1Division of Internal Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Insights
Treatment for cytomegalovirus (CMV) viremia did not reduce in-hospital deaths in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19). Further research is needed due to the study
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Virology
Background:
- Patients with coronavirus disease 2019 (COVID-19) in intensive care units (ICUs) often experience poor outcomes.
- Cytomegalovirus (CMV) reactivation is a common comorbidity in these critically ill patients, but its impact remains unclear.
- The study addresses the unknown implications of CMV reactivation in the context of severe COVID-19.
Purpose of the Study:
- To investigate whether treating cytomegalovirus (CMV) viremia improves in-hospital mortality among intensive care unit (ICU) patients diagnosed with COVID-19.
- To analyze the association between CMV viremia treatment and clinical outcomes in severe COVID-19 cases.
Main Methods:
- A single-center retrospective study analyzed 80 patients with COVID-19 pneumonia and CMV viremia admitted to the ICU.
- Patients were divided into two groups: those who received antiviral treatment (ganciclovir/valganciclovir) and those who did not.
- Primary endpoint was in-hospital mortality; secondary endpoints included length of stay, mechanical ventilation, and ECMO support.
Main Results:
- In-hospital mortality rates were similar between the treated (37.2%) and untreated (43.2%) groups (P=.749).
- No significant differences were observed in overall hospital length of stay.
- Patients receiving CMV treatment had a longer ICU length of stay and were more likely to be on ECMO and receive higher steroid doses.
Conclusions:
- Treatment of cytomegalovirus (CMV) viremia did not significantly reduce in-hospital mortality in COVID-19 patients admitted to the ICU.
- CMV viremia was associated with higher total steroid doses and prolonged ICU stays.
- The study highlights the need for further investigation, acknowledging the limitation of a small sample size.
Background:
Patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) have poor outcomes and frequently develop comorbid conditions, including cytomegalovirus (CMV) reactivation. The implications of CMV reactivation in this setting are unknown. We aimed to investigate if treatment of CMV viremia improved in-hospital mortality in ICU patients with COVID-19.
Methods:
In this single-center retrospective study, we analyzed clinical outcomes in patients diagnosed with COVID-19 pneumonia and CMV viremia admitted to an ICU from March 1, 2020, to April 30, 2021, who either received treatment (ganciclovir and/or valganciclovir) or received no treatment. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were total hospital length of stay (LOS), ICU LOS, requirement for extracorporeal membrane oxygenation (ECMO) support, duration of mechanical ventilation (MV), and predictors of in-hospital mortality.
Results:
A total of 80 patients were included, 43 patients in the treatment group and 37 in the control group. Baseline characteristics were similar in both groups. CMV-treated patients were more likely to test positive for CMV earlier in their course, more likely to be on ECMO, and received higher total steroid doses on average. In-hospital mortality was similar between the 2 groups (37.2% vs 43.2.0%; P = .749). There was no significant difference in hospital LOS, though CMV-treated patients had a longer ICU LOS.
Conclusions:
Treatment of CMV viremia did not decrease in-hospital mortality in ICU patients with COVID-19, but the sample size was limited. CMV viremia was significantly associated with total steroid dose received and longer ICU stay.
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