Association between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients
CCCF ePoster library. Lachance P. Nov 2, 2016; 151014; 132
Dr. Philippe Lachance
Dr. Philippe Lachance
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis


Association between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients


Lachance Philippe MD MSc1, Chen Justin MD2, Featherstone Robin MLIS3,  Sligl Wendy MD MSc1, 2

1 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

2 Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

3 Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
 
 


Abstract:

INTRODUCTION: Cytomegalovirus (CMV) reactivation in the critically ill is a well-recognized phenomenon. Previous studies exploring the association between CMV reactivation and outcomes in critically ill patients have yielded conflicting results1-3.

OBJECTIVES: To clarify if there is an association between CMV reactivation and worse patient-centered outcomes or increased health resource utilisation in immunocompetent critically ill patients.

METHODS: We searched electronic databases and grey literature for original studies and abstracts published between 1990 and 2016. The review was limited to studies including critically ill immunocompetent patients. CMV reactivation was defined as detectable DNAemia (most often by PCR), pp65 antigenemia or a positive culture. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT) and nosocomial infection. Health resource utilisation outcomes included ICU and hospital lengths of stay.  

RESULTS: Our search yielded 2683 citations; with 1841 remaining after removal of duplicates. Twenty studies and one abstract were included in the final analysis. CMV reactivation significantly increased ICU mortality [OR 2.47, 95% CI 1.72-3.54], long-term mortality [OR 1.89, 95% CI 1.40-2.55], the development of nosocomial infection [OR 3.20, 95% CI 2.05-4.98], duration of mechanical ventilation [OR 7.26, 95% CI 2.07-12.44], need for RRT [OR 2.37, 95% CI 1.31-4.31] and ICU length of stay [OR 8.25, 95% CI 5.64-10.86].

CONCLUSION: Cytomegalovirus reactivation is associated with worse patient-centered outcomes and measures of health resource utilisation in critically ill immunocompetent patients. More studies are needed to verify our results given the high risk of confounding and to determine if CMV has a real impact on ICU course or if it is only a surrogate for more severe illness.
 
 


References:

1. Ong DS, Klein Klouwenberg PM, Verduyn Lunel FM, et al. Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome*. Crit Care Med 2015;43(2):394- 400.

2. Walton AH, Muenzer JT, Rasche D, et al. Reactivation of multiple viruses in patients with sepsis. PLoS One 2014;9(2):e98819.

3. Frantzeskaki FG, Karampi ES, Kottaridi C, et al. Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers. J Crit Care 2015;30(2):276-81.
 



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