Association of cytomegalovirus infection with increased morbidity is independent of transfusion.
Forty-three consecutive trauma patients with an injury severity score greater than 20 were studied prospectively for evidence of cytomegalovirus (CMV) infection. Twenty-one patients had serologic conversion: 3 with primary CMV infections, 18 with reactivation of CMV infection (CMV group). Twenty-two patients had no serologic conversion (no CMV group). To differentiate the effects of CMV and transfusion, the CMV group and the no CMV group were each divided into high (more than 10 units) and low (less than 10 units) transfusion subgroups. Similar fever peaks, leukocyte counts, lymphocyte counts, and incidence of major bacterial sepsis were recorded for the four subgroups. Several factors were significantly associated with CMV infection independent of transfusion, including increased duration of major bacterial sepsis and number of septic episodes per patient; prolonged duration of anergy; increased duration of intensive care unit and hospital stay; increased duration of ventilatory assistance and rate of tracheostomy; and increased suppressor cells, decreased helper: suppressor ratios, increased functional suppressor cells, and increased natural killer cells. Although mortality was not increased with CMV infection, our data suggest that such infection after trauma may delay recovery from major bacterial infection, often resulting in a major increase in morbidity.
Curtsinger
L J
LJ
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292.
Cheadle
W G
WG
Hershman
M J
MJ
Cost
K
K
Polk
H C
HC
D000914:Antibodies, Viral / Q000032:analysis; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D006968:Hypersensitivity, Delayed; D007958:Leukocyte Count; D008214:Lymphocytes / Q000276:immunology; D011446:Prospective Studies; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications* / Q000276:immunology
D000914:Antibodies, Viral; D006684:HLA-DR Antigens