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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.
Insights
Cytomegalovirus (CMV) reactivation occurred in one-third of patients with acute necrotizing pancreatitis (ANP). Higher CMV viral loads correlated with worse clinical outcomes, highlighting a significant association in critically ill patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Virology
Background:
- Cytomegalovirus (CMV) reactivation is increasingly recognized in critically ill patients, even those not appearing immunocompromised.
- CMV reactivation has not been previously studied in patients with acute necrotizing pancreatitis (ANP).
Purpose of the Study:
- To investigate the incidence and clinical significance of CMV reactivation in adult patients with ANP.
- To determine the association between CMV viral load and clinical outcomes in ANP patients.
Main Methods:
- A prospective cohort study involving adult ANP patients admitted to the ICU.
- Weekly analysis of plasma, drain content, and necrotic tissue samples for CMV DNA.
- CMV reactivation defined as plasma viral load >1000 copies/mL.
Main Results:
- CMV reactivation was detected in 31.7% of ANP patients.
- Patients with CMV reactivation had higher rates of intra-abdominal and bloodstream infections.
- Higher CMV viral loads in plasma and drain samples were observed in non-survivors compared to survivors.
Conclusions:
- Approximately one-third of ANP patients experience CMV reactivation.
- Elevated and persistent CMV viral loads are linked to poorer clinical outcomes in ANP.
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