In Hematopoietic Stem Cell Transplantation (HSCT) recipients, Lower Respiratory Tract Infection (LRTI) is a leading cause of Intensive Care Units (ICU) admission and mortality. Although Cytomegalovirus (CMV) reactivation is a known risk factor for worse outcomes in HSCT recipients, the specific prognostic impact of CMV DNAemia on critically ill HSCT recipients with LRTI is not well-defined. This study aimed to determine the relationship between plasma CMV DNA levels at ICU admission and mortality in this high-risk population. This retrospective study collected adult patients who have admitted to a single-center ICU received HSCT and were diagnosed with LRTI. Based on plasma CMV DNA levels tested within 48 h of admission, patients were grouped as CMV positive (> 103 copies/mL) or CMV negative (≤ 103 copies/mL). We performed a 1:1 propensity score matching to control for confounding factors. The primary outcome was ICU mortality. Secondary outcomes including 1-year mortality, ventilator-free days, and ICU length of stay. Survival of CMV positive or negative patients was examined with Cox regression. From 606 eligible patients, each of 155 patients were matched for the two groups by propensity score matching. The CMV positive group exhibited a significantly higher ICU mortality rate compared to the CMV negative group (32.35% vs. 25.80%, P = 0.011). A Cox regression analysis, adjusted for age, WBC count, SOFA score, PaO₂/FiO₂, and GvHD, confirmed that CMV positivity was independently associated with a higher risk of 1-year mortality (HR = 1.27, 95% CI 1.10–2.33, P = 0.002). The ventilator-free days and ICU length of stay did not significantly differ between the two groups. In HSCT recipients admitted to the ICU with LRTI, CMV DNAemia at admission is an independent predictor of both short-term and long-term mortality.
Hu et al. (Tue,) studied this question.