AI Article Synopsis

  • - The study aimed to determine if reactivated cytomegalovirus (CMV) infections worsen the outcomes for critically ill patients or simply indicate more severe illness in those infected.
  • - In a cohort of 983 patients scheduled for on-pump surgery, they found that 63% were CMV-seropositive, and those seropositive patients had a significantly higher risk of needing reintubation compared to seronegative patients (10% vs. 4%).
  • - The results suggest that CMV reactivation increases the risk of complications, particularly reintubation post-surgery, indicating a potential need for monitoring and antiviral treatment in latently infected patients to manage these risks.

Article Abstract

Objective: To clarify whether reactivated cytomegalovirus (CMV) infections in critically ill patients lead to worse outcome or just identify more severely ill patients. If CMV has a pathogenic role, latently infected (CMV-seropositive) patients should have worse outcome than seronegative patients because only seropositive patients can experience a CMV reactivation.

Design: Post-hoc analysis of a prospective observational study.

Setting: Single university hospital.

Participants: The study comprised 983 consecutive patients scheduled for on-pump surgery.

Interventions: None.

Measurements And Main Results: CMV antibodies were analyzed in preoperative plasma samples. Postoperative adverse events (reintubation, low cardiac output or reinfarction, dialysis, stroke) and 30-day and 1-year mortality were evaluated prospectively. The plasma of reintubated patients and matched control patients was tested for CMV deoxyribonucleic acid, and 618 patients were found to be seropositive for CMV (63%). Among these, the risk for reintubation was increased (10% v 4%, p = 0.001). This increase remained significant after correction for confounding factors (odds ratio 2.70, p = 0.003) and was detectable from the third postoperative day throughout the whole postoperative period. Other outcome parameters were not different. Reintubated seropositive patients were more frequently CMV deoxyribonucleic acid-positive than were matched control patients (40% v 8%, p<0.001).

Conclusions: CMV-seropositive patients had an increased risk of reintubation after cardiac surgery, which was associated with reactivations of their CMV infections. Additional studies should determine whether this complication may be prevented by monitoring of latently infected patients and administering antiviral treatment for reactivated CMV infections.

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Source
http://dx.doi.org/10.1053/j.jvca.2016.10.024DOI Listing

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