Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers

Abstract Purpose Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect “immunocompetent” seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association...

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Veröffentlicht in:Journal of critical care 2015-04, Vol.30 (2), p.276-281
Hauptverfasser: Frantzeskaki, Frantzeska G., MD, Karampi, Eirini-Sofia, MD, Kottaridi, Christina, PhD, Alepaki, Maria, PhD, Routsi, Christina, PhD, Tzanela, Marinella, MD, Vassiliadi, Dimitra Argyro, MD, Douka, Evangelia, MD, Tsaousi, Sofia, MD, Gennimata, Vasiliki, PhD, Ilias, Ioannis, MD, Nikitas, Nikitas, MD, Armaganidis, Apostolos, PhD, Karakitsos, Petros, PhD, Papaevangelou, Vassiliki, PhD, Dimopoulou, Ioanna, PhD
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container_title Journal of critical care
container_volume 30
creator Frantzeskaki, Frantzeska G., MD
Karampi, Eirini-Sofia, MD
Kottaridi, Christina, PhD
Alepaki, Maria, PhD
Routsi, Christina, PhD
Tzanela, Marinella, MD
Vassiliadi, Dimitra Argyro, MD
Douka, Evangelia, MD
Tsaousi, Sofia, MD
Gennimata, Vasiliki, PhD
Ilias, Ioannis, MD
Nikitas, Nikitas, MD
Armaganidis, Apostolos, PhD
Karakitsos, Petros, PhD
Papaevangelou, Vassiliki, PhD
Dimopoulou, Ioanna, PhD
description Abstract Purpose Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect “immunocompetent” seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol. Methods This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon γ , interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor α were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded. Results During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation ( P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period ( P < .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups. Conclusions Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovir
doi_str_mv 10.1016/j.jcrc.2014.10.002
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The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol. Methods This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon γ , interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor α were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded. Results During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation ( P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period ( P &lt; .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups. Conclusions Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovirus reactivation was associated with more severe of organ dysfunction, but not with a worse clinical outcome.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2014.10.002</identifier><identifier>PMID: 25457114</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; Critical Care ; Critical Illness ; Cytokines ; Cytokines - immunology ; Cytomegalovirus ; Cytomegalovirus - genetics ; Cytomegalovirus - physiology ; Cytomegalovirus Infections - epidemiology ; Cytomegalovirus Infections - immunology ; Deoxyribonucleic acid ; DNA ; DNA, Viral - blood ; Female ; Gangrene ; Humans ; Illnesses ; Immunocompetence ; Incidence ; Infections ; Inflammatory biomarkers ; Inflammatory bowel disease ; Intensive care ; Intensive Care Units ; Laboratories ; Male ; Middle Aged ; Mortality ; Multiorgan dysfunction ; Multiple Organ Failure - epidemiology ; Multiple Organ Failure - immunology ; Organ Dysfunction Scores ; Plasma ; Polymerase chain reaction ; Prospective Studies ; Real-Time Polymerase Chain Reaction ; Respiration, Artificial ; Risk Factors ; Saliva - chemistry ; Sepsis ; Ventilation ; Virus Activation ; Young Adult ; Zinc Oxide-Eugenol Cement - analysis</subject><ispartof>Journal of critical care, 2015-04, Vol.30 (2), p.276-281</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-16199f9dafb11ef16bdf0297916c3bea6c80b00103df672f218f99e1b10aa71d3</citedby><cites>FETCH-LOGICAL-c472t-16199f9dafb11ef16bdf0297916c3bea6c80b00103df672f218f99e1b10aa71d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944114004092$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25457114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frantzeskaki, Frantzeska G., MD</creatorcontrib><creatorcontrib>Karampi, Eirini-Sofia, MD</creatorcontrib><creatorcontrib>Kottaridi, Christina, PhD</creatorcontrib><creatorcontrib>Alepaki, Maria, PhD</creatorcontrib><creatorcontrib>Routsi, Christina, PhD</creatorcontrib><creatorcontrib>Tzanela, Marinella, MD</creatorcontrib><creatorcontrib>Vassiliadi, Dimitra Argyro, MD</creatorcontrib><creatorcontrib>Douka, Evangelia, MD</creatorcontrib><creatorcontrib>Tsaousi, Sofia, MD</creatorcontrib><creatorcontrib>Gennimata, Vasiliki, PhD</creatorcontrib><creatorcontrib>Ilias, Ioannis, MD</creatorcontrib><creatorcontrib>Nikitas, Nikitas, MD</creatorcontrib><creatorcontrib>Armaganidis, Apostolos, PhD</creatorcontrib><creatorcontrib>Karakitsos, Petros, PhD</creatorcontrib><creatorcontrib>Papaevangelou, Vassiliki, PhD</creatorcontrib><creatorcontrib>Dimopoulou, Ioanna, PhD</creatorcontrib><title>Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Purpose Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect “immunocompetent” seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol. Methods This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon γ , interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor α were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded. Results During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation ( P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period ( P &lt; .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups. Conclusions Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovirus reactivation was associated with more severe of organ dysfunction, but not with a worse clinical outcome.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers</subject><subject>Critical Care</subject><subject>Critical Illness</subject><subject>Cytokines</subject><subject>Cytokines - immunology</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus - genetics</subject><subject>Cytomegalovirus - physiology</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Cytomegalovirus Infections - immunology</subject><subject>Deoxyribonucleic acid</subject><subject>DNA</subject><subject>DNA, Viral - blood</subject><subject>Female</subject><subject>Gangrene</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Immunocompetence</subject><subject>Incidence</subject><subject>Infections</subject><subject>Inflammatory biomarkers</subject><subject>Inflammatory bowel disease</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multiorgan dysfunction</subject><subject>Multiple Organ Failure - epidemiology</subject><subject>Multiple Organ Failure - immunology</subject><subject>Organ Dysfunction Scores</subject><subject>Plasma</subject><subject>Polymerase chain reaction</subject><subject>Prospective Studies</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>Respiration, Artificial</subject><subject>Risk Factors</subject><subject>Saliva - chemistry</subject><subject>Sepsis</subject><subject>Ventilation</subject><subject>Virus Activation</subject><subject>Young Adult</subject><subject>Zinc Oxide-Eugenol Cement - analysis</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks-O0zAQxiMEYsvCC3BAlrhwaIvHSZwEISRU8WellTgAZ8txxsVtYhdPUtQ34_FwtgtIe0CcRhr9vm80M1-WPQW-Bg7y5W69M9GsBYciNdaci3vZAsqyWtUSyvvZgtd1vmqKAi6yR0Q7zqHK8_JhdiHKoqwAikX2c3Maw4Bb3YejixOxiNqM7qhHFzxznmm2RY9R90vmg3fDMPlA0-EQkQi7RIzoyR2RGR2RTd6N7BAOU39j8IpdeeM69AaXLDraM5vcQ6Ql00TBuBuK2A83fmMhbrVn3Yns5M3cT5CfJ9heD4NOshNrXRh03GOkx9kDq3vCJ7f1Mvv6_t2XzcfV9acPV5u31ytTVGJcgYSmsU2nbQuAFmTbWS6aqgFp8ha1NDVv02F43llZCSugtk2D0ALXuoIuv8xenH0PMXyfkEY1ODLY99pjmEiBlLWQZc7r_0DLKhdplEzo8zvoLkzRp0Vmqqwk5KJKlDhTJgaiiFYdokv7nxRwNUdA7dQcATVHYO6lCCTRs1vrqR2w-yP5_fMEvD4DmM52dBgVGTe_qHMRzai64P7t_-aO3PTOO6P7PZ6Q_u6hSCiuPs8hnDMIBecFb0T-C60A27s</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Frantzeskaki, Frantzeska G., MD</creator><creator>Karampi, Eirini-Sofia, MD</creator><creator>Kottaridi, Christina, PhD</creator><creator>Alepaki, Maria, PhD</creator><creator>Routsi, Christina, PhD</creator><creator>Tzanela, Marinella, MD</creator><creator>Vassiliadi, Dimitra Argyro, MD</creator><creator>Douka, Evangelia, MD</creator><creator>Tsaousi, Sofia, MD</creator><creator>Gennimata, Vasiliki, PhD</creator><creator>Ilias, Ioannis, MD</creator><creator>Nikitas, Nikitas, MD</creator><creator>Armaganidis, Apostolos, PhD</creator><creator>Karakitsos, Petros, PhD</creator><creator>Papaevangelou, Vassiliki, PhD</creator><creator>Dimopoulou, Ioanna, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7U9</scope><scope>H94</scope></search><sort><creationdate>20150401</creationdate><title>Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers</title><author>Frantzeskaki, Frantzeska G., MD ; Karampi, Eirini-Sofia, MD ; Kottaridi, Christina, PhD ; Alepaki, Maria, PhD ; Routsi, Christina, PhD ; Tzanela, Marinella, MD ; Vassiliadi, Dimitra Argyro, MD ; Douka, Evangelia, MD ; Tsaousi, Sofia, MD ; Gennimata, Vasiliki, PhD ; Ilias, Ioannis, MD ; Nikitas, Nikitas, MD ; Armaganidis, Apostolos, PhD ; Karakitsos, Petros, PhD ; Papaevangelou, Vassiliki, PhD ; Dimopoulou, Ioanna, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-16199f9dafb11ef16bdf0297916c3bea6c80b00103df672f218f99e1b10aa71d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers</topic><topic>Critical Care</topic><topic>Critical Illness</topic><topic>Cytokines</topic><topic>Cytokines - immunology</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus - genetics</topic><topic>Cytomegalovirus - physiology</topic><topic>Cytomegalovirus Infections - epidemiology</topic><topic>Cytomegalovirus Infections - immunology</topic><topic>Deoxyribonucleic acid</topic><topic>DNA</topic><topic>DNA, Viral - blood</topic><topic>Female</topic><topic>Gangrene</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Immunocompetence</topic><topic>Incidence</topic><topic>Infections</topic><topic>Inflammatory biomarkers</topic><topic>Inflammatory bowel disease</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Laboratories</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multiorgan dysfunction</topic><topic>Multiple Organ Failure - epidemiology</topic><topic>Multiple Organ Failure - immunology</topic><topic>Organ Dysfunction Scores</topic><topic>Plasma</topic><topic>Polymerase chain reaction</topic><topic>Prospective Studies</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>Respiration, Artificial</topic><topic>Risk Factors</topic><topic>Saliva - chemistry</topic><topic>Sepsis</topic><topic>Ventilation</topic><topic>Virus Activation</topic><topic>Young Adult</topic><topic>Zinc Oxide-Eugenol Cement - analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frantzeskaki, Frantzeska G., MD</creatorcontrib><creatorcontrib>Karampi, Eirini-Sofia, MD</creatorcontrib><creatorcontrib>Kottaridi, Christina, PhD</creatorcontrib><creatorcontrib>Alepaki, Maria, PhD</creatorcontrib><creatorcontrib>Routsi, Christina, PhD</creatorcontrib><creatorcontrib>Tzanela, Marinella, MD</creatorcontrib><creatorcontrib>Vassiliadi, Dimitra Argyro, MD</creatorcontrib><creatorcontrib>Douka, Evangelia, MD</creatorcontrib><creatorcontrib>Tsaousi, Sofia, MD</creatorcontrib><creatorcontrib>Gennimata, Vasiliki, PhD</creatorcontrib><creatorcontrib>Ilias, Ioannis, MD</creatorcontrib><creatorcontrib>Nikitas, Nikitas, MD</creatorcontrib><creatorcontrib>Armaganidis, Apostolos, PhD</creatorcontrib><creatorcontrib>Karakitsos, Petros, PhD</creatorcontrib><creatorcontrib>Papaevangelou, Vassiliki, PhD</creatorcontrib><creatorcontrib>Dimopoulou, Ioanna, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health &amp; Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health &amp; Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frantzeskaki, Frantzeska G., MD</au><au>Karampi, Eirini-Sofia, MD</au><au>Kottaridi, Christina, PhD</au><au>Alepaki, Maria, PhD</au><au>Routsi, Christina, PhD</au><au>Tzanela, Marinella, MD</au><au>Vassiliadi, Dimitra Argyro, MD</au><au>Douka, Evangelia, MD</au><au>Tsaousi, Sofia, MD</au><au>Gennimata, Vasiliki, PhD</au><au>Ilias, Ioannis, MD</au><au>Nikitas, Nikitas, MD</au><au>Armaganidis, Apostolos, PhD</au><au>Karakitsos, Petros, PhD</au><au>Papaevangelou, Vassiliki, PhD</au><au>Dimopoulou, Ioanna, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>30</volume><issue>2</issue><spage>276</spage><epage>281</epage><pages>276-281</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Purpose Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect “immunocompetent” seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol. Methods This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon γ , interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor α were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded. Results During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation ( P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period ( P &lt; .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups. Conclusions Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovirus reactivation was associated with more severe of organ dysfunction, but not with a worse clinical outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25457114</pmid><doi>10.1016/j.jcrc.2014.10.002</doi><tpages>6</tpages></addata></record>
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1557-8615
language eng
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source MEDLINE; Elsevier ScienceDirect Journals
subjects Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers
Critical Care
Critical Illness
Cytokines
Cytokines - immunology
Cytomegalovirus
Cytomegalovirus - genetics
Cytomegalovirus - physiology
Cytomegalovirus Infections - epidemiology
Cytomegalovirus Infections - immunology
Deoxyribonucleic acid
DNA
DNA, Viral - blood
Female
Gangrene
Humans
Illnesses
Immunocompetence
Incidence
Infections
Inflammatory biomarkers
Inflammatory bowel disease
Intensive care
Intensive Care Units
Laboratories
Male
Middle Aged
Mortality
Multiorgan dysfunction
Multiple Organ Failure - epidemiology
Multiple Organ Failure - immunology
Organ Dysfunction Scores
Plasma
Polymerase chain reaction
Prospective Studies
Real-Time Polymerase Chain Reaction
Respiration, Artificial
Risk Factors
Saliva - chemistry
Sepsis
Ventilation
Virus Activation
Young Adult
Zinc Oxide-Eugenol Cement - analysis
title Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers
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