Predictive Factors of Cytomegalovirus Viremia during the Clinical Course of Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Single Center Observational Study

Abstract

We aim to elucidate factors to aid in the prediction of cytomegalovirus viremia during the treatment of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We conducted a single-center, retrospective, observational study of 35 patients with newly diagnosed AAV. Factors associated with the development of CMV viremia were investigated via a logistic regression analysis. The CMV antigenemia test was performed in 25 patients (71%), of whom 15 (60%) were diagnosed with CMV viremia. Of these 15 patients, 5 developed a CMV infection. The total protein, hemoglobin, platelet count and lymphocyte counts at the time of the CMV antigenemia test were significantly lower in patients who developed CMV viremia. In addition, total protein, hemoglobin, platelet count and lymphocyte count also presented significantly decreasing trends in the following order: patients who did not develop CMV viremia, patients who developed CMV viremia without any symptoms, and patients who developed CMV infection. All patients with CMV recovered. In conclusion, the total protein, hemoglobin, platelet count and lymphocyte count may be useful markers for the prediction of CMV viremia and infection after the start of induction of immunosuppressive therapy for patients with AAV.

Investigation of Clinical Features and Association between Vascular Endothelial Injury Markers and Cytomegalovirus Infection Associated with Thrombotic Microangiopathy in Patients with Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: Case-Based Research

“…Previous studies suggested predictive factors of CMV viremia during the clinical course of AAV. Low levels of total protein, hemoglobin, platelet count, lymphocytopenia, a high dose of glucocorticoid therapy, and oral candida infection may be useful markers for the prediction of CMV viremia during the treatment of AAV [8,[46][47][48]. However, these studies did not extensively discuss any specific predictive markers associated with CMV-AAV or CMV-AAV-TMA.…”

“…The dataset utilized in our previous study was analyzed here [8,13]. Candidates for living-donor kidney transplantation were analyzed as a control and 26 cases of newly developed AAV who underwent kidney biopsy without TMA were analyzed as AAV cases.…”

“…Candidates for living-donor kidney transplantation were analyzed as a control and 26 cases of newly developed AAV who underwent kidney biopsy without TMA were analyzed as AAV cases. The details of the data were previously described [8,13]. The current study was approved by the institutional review board of the ethical committee of Shinshu University School of Medicine (approval number: 6036) and was conducted in accordance with the principles of the Declaration of Helsinki.…”

“…We evaluated the association between CMV viremia and the three vascular endothelial markers, serum sulfatides, soluble thrombomodulin, and pentraxin 3, using univariate logistic regression analyses. The data analyses were based on the dataset used in the previous study [8]. From the dataset, 25 patients with AAV who were evaluated for CMV-pp65-antigen-positive cell count were analyzed.…”

“…Cytomegalovirus (CMV) is recognized as a cause of opportunistic infection in patients undergoing immunosuppressive therapy. Patients with AAV are also known to be at high risk of CMV reactivation and subsequent organ injury [8]. Additionally, CMV is known to infect vascular endothelial cells that may be associated with severe CMV infection, resulting in the development of TMA [9].…”