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

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 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.研究目的：巨细胞病毒（Cytomegaloviruses, CMV）对免疫功能低下患者的预后可产生显著不良影响。相较于移植及艾滋病领域，自身免疫领域中有关CMV感染的研究报道较为匮乏。本研究于单中心三级医疗机构开展，旨在探讨自身免疫病患者合并CMV感染的临床结局。 研究方法：本研究采用回顾性研究设计，旨在明确自身免疫病患者合并CMV感染的死亡危险因素。我们回顾了2005年12月至2016年3月期间，经实时定量聚合酶链反应（real-time quantitative polymerase chain reaction）确诊为CMV感染的自身免疫病患者的病历资料，对其临床与实验室指标、治疗结局进行了系统性分析。 研究结果：本研究共纳入73例CMV感染患者，按临床结局分为存活组与非存活组。非存活组的CMV-DNA中位拷贝数显著高于存活组（95500 vs 6700 copies/mL，P=0.005），且CMV肺炎的发生率显著更高（69.2% vs 36.2%，P=0.007）。校正多种混杂协变量后，log转换的CMV-DNA拷贝数/mL（风险比（hazard ratio）：1.48；95%置信区间（confidence interval）：1.14~1.92；P=0.003）及合并感染的存在（风险比（hazard ratio）：22.00；95%置信区间（confidence interval）：2.75~175.97，P=0.004）被确定为独立死亡危险因素。此外，CMV拷贝数较高（>60000 copies/mL）的患者，其住院死亡率显著高于拷贝数较低的患者（原文此处P值缺失）。 研究结论：CMV-DNA拷贝数及合并感染可作为自身免疫病合并CMV感染患者住院死亡率的独立预测因子。因此，对于合并CMV感染的自身免疫病患者，建议连续监测CMV-DNA拷贝数，并密切观察其他感染的相关临床体征。