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Published on: July 6, 2013
Risk factors and outcomes of cytomegalovirus infection in the intensive care unit
Mohamad Ali Tfaily1, Joe-David Azzo2, Amal Gharamti3
1Emory University, Atlanta, GA, United States.
Introduction:
Cytomegalovirus (CMV) infection has long been recognized as an important viral syndrome in the immunocompromised host. The disease is less well described in critically-ill patients. We evaluated the risk factors for the development of CMV infection in patients admitted to the intensive care unit (ICU). We also compared the outcomes of CMV infection in ICU patients to those of patients with hematological malignancies.
Methodology:
This is a retrospective study composed of three arms: patients admitted to the ICU with infection (ICU + / CMV + arm), patients admitted to the ICU who did not develop CMV infection (ICU + / CMV- arm, and patients with hematological malignancies on the hematology ward without CMV infection (ICU - / CMV + arm).
Results:
Patients who were admitted to ICU for surgical causes had a decreased risk of CMV infection. On the other hand, receiving corticosteroids and vasoactive drugs was associated with an increased risk of CMV infection with adjusted odds ratios (aOR) of 2.4 and 25.3, respectively. Mortality was higher in ICU + / CMV + patients compared to ICU - / CMV + patients. In the ICU + /CMV + population, male sex and being on mechanical ventilation after CMV infection were independent predictors of mortality (aOR 4.6 and 5.0, respectively).
Conclusions:
CMV infection in ICU patients is a potentially serious disease requiring close attention. The findings from our study help in identifying patients in the ICU at risk for CMV infection, thereby warranting frequent screening. Patients at high risk of death (male, on mechanical ventilation) should receive prompt treatment and intensive follow-up.
Insights
Cytomegalovirus (CMV) infection poses a serious risk in intensive care units (ICUs). Corticosteroids and vasoactive drugs increase CMV risk, while male sex and mechanical ventilation predict mortality in infected ICU patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) infection is a known syndrome in immunocompromised individuals.
- CMV disease is less understood in critically ill patients.
- This study investigates risk factors and outcomes of CMV infection in intensive care unit (ICU) patients.
Purpose of the Study:
- To evaluate risk factors for CMV infection development in ICU patients.
- To compare outcomes of CMV infection in ICU patients versus those with hematological malignancies.
Main Methods:
- Retrospective study with three arms: ICU patients with CMV, ICU patients without CMV, and non-ICU hematology patients with CMV.
- Analysis of risk factors including corticosteroid and vasoactive drug use.
- Comparison of mortality rates and predictors between patient groups.
Main Results:
- Surgical ICU admission was associated with decreased CMV risk.
- Corticosteroids (aOR 2.4) and vasoactive drugs (aOR 25.3) significantly increased CMV risk.
- Mortality was higher in CMV-infected ICU patients compared to non-ICU patients with CMV.
- Male sex (aOR 4.6) and mechanical ventilation (aOR 5.0) predicted mortality in ICU patients with CMV.
Conclusions:
- CMV infection in ICU patients is a serious condition requiring vigilance.
- Identifies ICU patients at risk for CMV infection, suggesting frequent screening.
- Highlights high-risk groups (male, mechanically ventilated) needing prompt treatment and follow-up.
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