Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome*.
OBJECTIVE
Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus seropositive patients admitted to the ICU with acute respiratory distress syndrome has therefore been proposed. We assessed cytomegalovirus seroprevalence as a risk factor for morbidity and mortality in patients with acute respiratory distress syndrome.


METHODS
Prospective observational cohort study. We used the number of days alive and free of mechanical ventilation on day 28 as a composite outcome measure and used multivariable ordinal logistic regression analyses to adjust for potential confounders.


METHODS
ICUs of two tertiary care hospitals in The Netherlands.


METHODS
We included all newly admitted patients with acute respiratory distress syndrome who received mechanical ventilation for at least 4 days. Patients with known immunocompromise and those receiving antiviral treatment prior to ICU admission were excluded.


METHODS
None.


RESULTS
Over a 2-year period, 306 patients were included, 209 (68%) of whom were cytomegalovirus seropositive. Cytomegalovirus reactivation occurred in 53 of these cases (26%). One hundred patients (33%) died or continued to be mechanically ventilated by day 28. After adjustment for confounding, cytomegalovirus seroprevalence was not associated with the primary outcome (crude odds ratio, 1.09; 95% CI, 0.70-1.70; adjusted odds ratio, 1.01; 95% CI, 0.64-1.59). Seroprevalence was also not associated with poor outcome in any of the prespecified subgroup analyses. However, a significant association was found in a post hoc subgroup of patients who had developed acute respiratory distress syndrome in a setting of septic shock (adjusted odds ratio, 2.86; 95% CI, 1.32-6.23). The time course of pulmonary markers in survivors was comparable between the two serogroups.


CONCLUSIONS
Cytomegalovirus seroprevalence is not associated with prolonged mechanical ventilation or increased mortality in critically ill patients with acute respiratory distress syndrome, with possible exception of patients presenting with septic shock. Therefore, a prevention strategy targeting an unselected cohort of seropositive patients with acute respiratory distress syndrome is unlikely to show any meaningful benefit.
1Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. 2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 4Department of Mathematics, Utrecht University, Utrecht, The Netherlands. 5Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
David S Y
DS
Ong
Peter M C
PM
Klein Klouwenberg
Frans M
FM
Verduyn Lunel
Cristian
C
Spitoni
Jos F
JF
Frencken
Huberta A T
HA
Dekker
Marcus J
MJ
Schultz
Marc J M
MJ
Bonten
Olaf L
OL
Cremer
D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy; D018890:Chemoprevention; D016638:Critical Illness; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D016036:Seroepidemiologic Studies
D000998:Antiviral Agents