Cytomegalovirus (CMV) infection in patients with cellular immune deficiencies is associated with significant morbidity and mortality. However, data on CMV end-organ disease (CMV-EOD) in critically ill, immunocompromised patients are scarce. Our objective here was to describe the clinical characteristics and outcomes of CMV-EOD in this population. We conducted a multicenter, international, retrospective, observational study in adults who had CMV-EOD and were admitted to any of 18 intensive care units (ICUs) in France, Israel, and Spain in January 2010–December 2021. Patients with AIDS were excluded. We collected the clinical characteristics and outcomes of each patient. Survivors and non-survivors were compared, and multivariate analysis was performed to identify risk factors for hospital mortality. We studied 185 patients, including 80 (43.2%) with hematologic malignancies, 55 (29.7%) with solid organ transplantation, 31 (16.8%) on immunosuppressants, 16 (8.6%) with solid malignancies, and 3 (1.6%) with primary immunodeficiencies. The most common CMV-EOD was pneumonia (n = 115, [62.2%] including 55 [47.8%] with a respiratory co-pathogen), followed by CMV gastrointestinal disease (n = 64 [34.6%]). More than one organ was involved in 16 (8.8%) patients. Histopathological evidence was obtained for 10/115 (8.7%) patients with pneumonia and 43/64 (67.2%) with GI disease. Other opportunistic infections were diagnosed in 69 (37.3%) patients. Hospital mortality was 61.4% overall and was significantly higher in the group with hematologic malignancies (75% vs. 51%, P = 0.001). Factors independently associated with higher hospital mortality were hematologic malignancy with active graft-versus-host disease (OR 5.02; 95% CI 1.15–27.30), CMV pneumonia (OR 2.57; 95% CI 1.13–6.03), lymphocytes < 0.30 × 109/L at diagnosis of CMV-EOD (OR 2.40; 95% CI 1.05–5.69), worse SOFA score at ICU admission (OR 1.18; 95% CI 1.04–1.35), and older age (OR 1.04; 95% CI 1.01–1.07). Mortality was high in critically ill, immunocompromised patients with CMV-EOD and varied considerably with the cause of immunodeficiency and organ involved by CMV. Three of the four independent risk factors identified here are also known to be associated with higher mortality in the absence of CMV-EOD. CMV pneumonia was rarely proven by histopathology and was the most severe CMV-EOD.

中文翻译：

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巨细胞病毒终末器官疾病免疫功能低下危重患者的临床特征和结局：多中心回顾性队列研究


细胞免疫缺陷患者的巨细胞病毒（CMV）感染与显着的发病率和死亡率相关。然而，关于重症、免疫功能低下患者的 CMV 终末器官疾病 (CMV-EOD) 的数据很少。我们的目标是描述该人群 CMV-EOD 的临床特征和结果。我们对 2010 年 1 月至 2021 年 12 月期间入住法国、以色列和西班牙 18 个重症监护病房 (ICU) 的 CMV-EOD 成人进行了一项多中心、国际、回顾性观察性研究。艾滋病患者被排除在外。我们收集了每位患者的临床特征和结果。对幸存者和非幸存者进行比较，并进行多变量分析以确定医院死亡的危险因素。我们研究了 185 名患者，其中 80 名（43.2%）患有血液恶性肿瘤，55 名（29.7%）接受实体器官移植，31 名（16.8%）接受免疫抑制剂，16 名（8.6%）患有实体恶性肿瘤，3 名（1.6%）患有原发性恶性肿瘤。免疫缺陷。最常见的 CMV-EOD 是肺炎（n = 115，[62.2%]，其中 55 [47.8%] 伴有呼吸道共病原体），其次是 CMV 胃肠道疾病（n = 64 [34.6%]）。 16 名患者 (8.8%) 涉及多个器官。 10/115 (8.7%) 的肺炎患者和 43/64 (67.2%) 的胃肠道疾病患者获得了组织病理学证据。 69 名 (37.3%) 患者诊断出其他机会性感染。医院死亡率总体为 61.4%，并且血液系统恶性肿瘤组的住院死亡率显着较高（75% vs. 51%，P = 0.001）。与较高医院死亡率独立相关的因素是血液系统恶性肿瘤伴活动性移植物抗宿主病（OR 5.02；95% CI 1.15–27.30）、巨细胞病毒肺炎（OR 2.57；95% CI 1.13–6）。03)、诊断 CMV-EOD 时淋巴细胞 < 0.30 × 109/L (OR 2.40; 95% CI 1.05–5.69)、入住 ICU 时 SOFA 评分较差 (OR 1.18; 95% CI 1.04–1.35) 以及年龄较大（OR 1.04；95% CI 1.01–1.07）。患有 CMV-EOD 的重症、免疫功能低下患者的死亡率很高，并且随着免疫缺陷的原因和 CMV 所累及的器官的不同而有很大差异。这里确定的四个独立危险因素中的三个也已知在没有 CMV-EOD 的情况下与较高的死亡率相关。 CMV 肺炎很少得到组织病理学证实，是最严重的 CMV-EOD。