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Cytomegalovirus Reactivation in Critically Ill Patients With Acute Necrotizing Pancreatitis
Umadri Singh1, Mohan Gurjar1, Atul Garg2
1Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Background:
In recent years, cytomegalovirus (CMV) reactivation has been recognized during the critical illness of apparently nonimmunosuppressed patients, impacting their clinical outcomes. However, no study is available on CMV reactivation among acute necrotizing pancreatitis (ANP) patients.
Methods:
In this prospective cohort study of adult ANP patients requiring intensive care unit admission with apparently immunocompetent and CMV seropositive status, clinical samples were analyzed on a weekly basis for CMV copies. CMV reactivation was considered when the viral load exceeded 1000 copies/mL in plasma.
Results:
During the study period, 284 samples (plasma 149, drain content 125, and necrotic tissue 10) were analyzed from 41 ANP patients. At enrollment, the median (interquartile range) age was 35 (25-40) years, SOFA score was 7 (6-9), and computed tomography severity index of pancreatitis was 10 (6-10). CMV reactivation was detected in the plasma of 13 patients (31.7%) with an average viral load (range) of 3900 (1500-5600) copies/mL. These patients had higher rates of intra-abdominal (92%) and bloodstream infections (77%). Among these individuals, the maximum CMV in plasma was 8180 (7500-38 500) copies/mL and 3200 (2250-4075) copies/mL (P = .01), while in drain samples it was 81 675 (63 750-101 750) copies/mL and 17 250 (6077-41 952) copies/mL (P = .02), in nonsurvivors and survivors, respectively. CMV copies (per mL) in the pancreatic necrosum (n = 7) were higher 29 200 (14 700-47 500) compared with concurrent samples of drain (10 000 [4135-31 250]) and plasma (1500 [0-12 955]) from the same patients (P = .48).
Conclusions:
Up to one-third of ANP patients experienced CMV reactivation. Higher and persistent CMV copies in the clinical samples were associated with poorer clinical outcomes.
Clinicaltrialsgov Identifier:
NCT05898048.
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