title: Cytomegalovirus Serostatus as Predictor for Adverse Events After Cardiac Surgery: A Prospective Observational Study.
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.
  
  
  METHODS
  Post-hoc analysis of a prospective observational study.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  The study comprised 983 consecutive patients scheduled for on-pump surgery.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein. Electronic address: Malte.Ziemann@uksh.de.
authors.forename: Malte
authors.initials: M
authors.lastname: Ziemann
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Lübeck.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.affiliation: Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lenor
authors.affiliation: Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein.
authors.forename: David
authors.initials: D
authors.lastname: Juhl
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Petersen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Lübeck.
authors.forename: Julika
authors.initials: J
authors.lastname: Schön
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Lübeck.
authors.forename: Hermann
authors.initials: H
authors.lastname: Heinze
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Lübeck.
authors.forename: Heinrich V
authors.initials: HV
authors.lastname: Groesdonk
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Lübeck.
authors.forename: Hauke
authors.initials: H
authors.lastname: Paarmann
authors.affiliation: Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein.
authors.forename: Holger
authors.initials: H
authors.lastname: Hennig
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: adverse events; cardiac surgery; cytomegalovirus deoxyribonucleic acid; cytomegalovirus serostatus; latent cytomegalovirus infection; reintubation