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Associated Factors on Cytomegalovirus Reactivation in Patients with COVID-19 in the Intensive Care Unit

Sumeyye Kazancioglu1, Ebru Ayozturk2, Seval Izdes2

  • 1Ankara Bilkent City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.

Mediterranean Journal of Hematology and Infectious Diseases
|July 16, 2026
PubMed
Abstract

Insights

Cytomegalovirus (CMV) reactivation in critically ill patients is linked to higher mortality and longer ICU stays. Lower hemoglobin and elevated ALT levels may indicate CMV reactivation, aiding early detection.

Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Virology

Background:

  • Critically ill patients in intensive care units (ICUs) are prone to cytomegalovirus (CMV) reactivation.
  • CMV reactivation is associated with increased mortality, prolonged ICU stays, and extended mechanical ventilation (MV).

Purpose of the Study:

  • To investigate the clinical outcomes and identify indicators of CMV reactivation in severe COVID-19 patients.

Main Methods:

  • A comparative study involving severe COVID-19 patients with CMV reactivation (n=39) treated with ganciclovir versus a control group without reactivation (n=39).
  • Analysis of mortality rates, duration of steroid treatment, MV duration, hemoglobin levels, and alanine aminotransferase (ALT) levels.

Main Results:

  • The CMV reactivation group had significantly higher mortality (71.8%) compared to the control group (38.5%).
  • Factors associated with CMV reactivation included steroid treatment, prolonged MV, and lower hemoglobin (≤ 9.8 g/dL).
  • Elevated ALT levels were significantly higher in the reactivation group, serving as a potential indicator (AUC: 0.721).

Conclusions:

  • CMV reactivation in critically ill patients correlates with prolonged ICU stays, mechanical ventilation, and steroid therapy.
  • Low hemoglobin and elevated ALT levels are potential clinical markers for identifying CMV reactivation in this patient population.
Keywords:
Antiviral therapyCOVID-19Critically illCytomegalovirusHemoglobinIntensive care unit

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