Predictors of mortality in autoimmune disease patients with concurrent cytomegalovirus infections detected by quantitative real-time PCR

Abstract

ObjectiveCytomegaloviruses (CMV) can have a significant impact on the prognosis of immunocompromised patients. Unlike in the transplantation and AIDS fields, only a few studies on CMV infections have been published in the field of autoimmunity. In this study, we examined the clinical outcomes of CMV infections in patients with autoimmune diseases at a single tertiary medical institution.MethodsA retrospective study was performed to identify the mortality risk factors associated with CMV infections in patients with autoimmune diseases. We reviewed the medical records of patients with autoimmune diseases who were diagnosed with CMV infections using real-time quantitative polymerase chain reaction between December 2005 and March 2016. Clinical and laboratory parameters as well as treatment outcomes were analyzed.ResultsSeventy-three CMV infected patients were separated into survivors and non-survivors. Non-survivors had significantly higher median CMV-DNA copy numbers than survivors (95,500 vs 6,700 copies/mL, p = 0.005) and demonstrated significantly more frequent incidents of CMV pneumonitis (69.2 vs 36.2%, p = 0.007). After adjusting for multiple confounding covariates, the log CMV-DNA copies/mL (hazard ratio, 1.48; 95% confidence interval, 1.14–1.92; p = 0.003) and the presence of concurrent infections (hazard ratio, 22.00; 95% confidence interval, 2.75–175.97, p = 0.004) were identified as independent mortality risk factors. Furthermore, patients with high CMV copy numbers (> 60,000 copies/mL) had higher in-hospital mortality than those with low CMV copy numbers (p < 0.05).ConclusionsCMV-DNA copy numbers and concurrent infections are predictors of in-hospital mortality in CMV-infected patients with autoimmune diseases. Therefore, serial measurements of CMV-DNA copy numbers and close observation for signs of other infections are recommended for patients with autoimmune diseases who have concurrent CMV infection.

Unusual cause for intestinal perforation in juvenile dermatomyositis

“…Takizawa et al have found that pulsed MPSL raises the chance of CMV infection and mortality rate significantly when administered additionally to other therapeutic agents 7. Lee et al established that patients with high titre of CMV PCR (>60 000 copies/mL) had higher hospital mortality rates 16. Our patient’s CMV PCR was 15 924 copies/mL.…”

A Prospective Study of Cytomegalovirus-Specific Cell-Mediated Immune Monitoring and Cytomegalovirus Infection in Patients With Active Systemic Lupus Erythematosus Receiving Immunosuppressants

“…The incidence of CMV infection among SLE patients receiving intense immunosuppressants is higher compared with other patients with autoimmune diseases. The incidence reported in the literature ranges from 37% to 53% depending on the definition (from asymptomatic CMV DNAemia to tissue-invasive disease) [ 18 , 19 ]. By contrast, we found that ~13% of active SLE patients receiving immunosuppressants suffered from CMV infection with a plasma CMV DNA load of ≥3 log10 IU/mL, which required treatment.…”

Cytomegalovirus infection in Systemic Lupus Erythematosus: report of four cases challenging the management of the disease, and literature review

“…performed a retrospective study to identify the mortality risk factors associated with CMV infections in patients with autoimmune diseases. 13 They showed that CMV-DNA copy numbers and concurrent infections are predictors of in-hospital mortality in CMV-infected patients with autoimmune diseases. Therefore, they recommend serial measurements of CMV-DNA copy numbers and close observation for signs of other infections for patients with autoimmune diseases who have concurrent CMV infection.…”

“…Therefore, they recommend serial measurements of CMV-DNA copy numbers and close observation for signs of other infections for patients with autoimmune diseases who have concurrent CMV infection. 13…”