title: Provision of prognostic information in immunocompromised patients by routine application of the polymerase chain reaction for cytomegalovirus.
abstract: A polymerase chain reaction (PCR) assay that amplifies a 149 base pair fragment of the cytomegalovirus glycoprotein B gene was used in the routine screening of 548 urine and 248 blood specimens from immunocompromised patients. The PCR results were compared with those obtained for the same specimens tested by the methods of conventional cell culture (CCC) and detection of CMV-specific immediate-early antigen fluorescent foci (DEAFF). For both urine and blood, PCR positivity correlated with a positive result in CCC (urine 93.2%; blood 86%). As expected for a more sensitive assay, PCR also identified CMV in samples that were negative by CCC and DEAFF such that there was no concordance between tests (Kappa test P > 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of PCR positivity in blood with respect to CMV disease were 0.8, 0.86, 0.62, and 0.94, respectively, with an associated relative risk of 5.84 (95% CI; 3.2-10.8). PCR detection of CMV in urine was more sensitive than either DEAFF or CCC (0.6 vs. 0.35 and 0.5, respectively) and had a high negative predictive value (0.89) but the positive predictive value was lower than either CCC or DEAFF (0.32 vs. 0.41 and 0.37, respectively) with respect to disease. Longitudinal data on patients with disease showed that CMV in blood was detected at a median of 5 days (range; -20 to +3 days) before disease onset whereas CMV was detected by CCC at a median of 13 days (range -4 to +20 days) after disease onset. In addition, the PCR assay was integrated into the battery of tests routinely performed on transplant patients in the diagnostic laboratory at this institution.
authors.affiliation: Division of Communicable Diseases, Royal Free Hampstead NHS Trust and School of Medicine, London, United Kingdom.
authors.forename: I M
authors.initials: IM
authors.lastname: Kidd
authors.forename: J C
authors.initials: JC
authors.lastname: Fox
authors.forename: D
authors.initials: D
authors.lastname: Pillay
authors.forename: H
authors.initials: H
authors.lastname: Charman
authors.forename: P D
authors.initials: PD
authors.lastname: Griffiths
authors.forename: V C
authors.initials: VC
authors.lastname: Emery
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology; D001769:Blood / Q000382:microbiology; D016026:Bone Marrow Transplantation / Q000276:immunology*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011379:Prognosis; D013997:Time Factors; D014556:Urine / Q000382:microbiology