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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免疫功能低下巨细胞病毒终末器官疾病危重症患者的临床特征和结局： 一项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） 感染与显着的并发症发生率和死亡率相关。然而，关于危重症、免疫功能低下患者的 CMV 终末器官疾病 （CMV-EOD） 的数据很少。我们的目的是描述 CMV-EOD 在该人群中的临床特征和结果。我们在 2010 年 1 月至 2021 年 12 月期间在法国、以色列和西班牙的 18 个重症监护病房 （ICU） 中收治的患有 CMV-EOD 的成年人进行了一项多中心、国际、回顾性、观察性研究。AIDS 患者被排除在外。我们收集了每位患者的临床特征和结局。比较幸存者和非幸存者，并进行多变量分析以确定住院死亡的危险因素。我们研究了 185 例患者，包括 80 例 （43.2%） 血液系统恶性肿瘤，55 例 （29.7%） 实体器官移植，31 例 （16.8%） 免疫抑制剂患者，16 例 （8.6%） 实体恶性肿瘤，3 例 （1.6%） 原发性免疫缺陷。最常见的 CMV-EOD 是肺炎 （n = 115， [62.2%] 包括 55 [47.8%] 与呼吸道混合病原体），其次是 CMV 胃肠道疾病 （n = 64 [34.6%]）。16 例 （8.8%） 患者累及不止一个器官。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 例 （37.3%） 患者诊断出其他机会性感染。总体住院死亡率为 61.4%，血液系统恶性肿瘤组的住院死亡率显著更高 （75% vs. 51%，P = 0.001）。与较高住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）、CMV 肺炎 （OR 2.57;95% CI 1.13-6。03）、诊断为 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） 和年龄较大 （OR 1.04;95% CI 1.01-1.07）。CMV-EOD 危重、免疫功能低下患者的死亡率很高，并且因免疫缺陷的原因和 CMV 受累器官而异。此处确定的 4 个独立危险因素中的 3 个也已知与在没有 CMV-EOD 的情况下较高的死亡率相关。CMV 肺炎很少通过组织病理学证实，是最严重的 CMV-EOD。