Abstract
BACKGROUND: Cytomegalovirus (CMV) infection is not very uncommon in critically ill patients as per the studies in past decade. However, the incidence of active CMV infection and its association with clinical outcomes have not been studied for critically ill non-immunosuppressed cirrhotic adults. METHODS: We prospectively evaluated active CMV infection (CMV-plasma-DNAemia; > 500 IU/mL) by real-time polymerase chain reaction and clinical outcome in sero-positive (anti CMV IgG-positive) critically ill non-immunosuppressed adults with chronic liver diseases (all cirrhotics) at day 0, 7, 14 and 21 in Liver-ICU. Patients with prior CMV infection (on day 0) were excluded. RESULTS: A total of 166 blood samples were collected from 84 enrolled Liver-ICU patients [73 men, median age: 49.5 years, interquartile range (IQR): 40–57.5]. Of 84, 29 died/discharged before day 7, leaving 55 patients in study. Cumulative incidence of active CMV infection was 30.9% (95% confidence interval, CI: 19.1–44.80) at 7-day follow-up. The incidence rate (or density) of active CMV infection was 2.75% per person-day (95% CI: 1.68–4.26% person-day) during 21-day follow-up. Acute on chronic liver failure (n = 12, 63.16%; P = 0.003) was the most common clinical presentation among patients with active CMV infection. On multivariate analysis, significant factors for active CMV infection were bacterial infections (P = 0.031, odds ratio (OR): 0.07, 95% CI: 0.01- 0.78) and leucocytosis (P = 0.047, OR: 1.15, 95% CI: 1.00–1.32). ICU-Mortality did not differ between patients with and without active CMV infection (90% vs. 88.57%, P = 1.00). In Cox-regression analysis, active CMV infection was not independently associated with time to death [Hazard Ratio (HR) = 1.18, 95% CI: 0.65 to 2.15, P = 0.58] as well as length of stay (LOS) in ICU (9.50, IQR 8–16.50 vs. 12, IQR 8–18 days; HR: 1.12; 95% CI: 0.64–1.97, P = 0.68). CONCLUSION: Incidence rate of active CMV infection is considerable in critically ill non-immunosuppressed cirrhotic adults. This study did not find significant association of active CMV infection with ICU-mortality and LOS in ICU among critically ill cirrhotic patients. Further studies with optimum frequency for monitoring of active CMV infection are needed to clarify its impact on clinical outcomes. DISCLOSURES: All authors: No reported disclosures.