Clinical Profile, Intensive Care Unit Course, and Outcomes of COVID-19 Patients with Cytomegalovirus Infection

Abstract

Abstract Background and Aim: Active cytomegalovirus (CMV) infection can occur in up to 36% of critically ill patients. Severe COVID-19 disease has all risk factors that predispose to CMV infection. CMV infection can be associated with increased morbidity and mortality and could be an occult cause of nonimprovement in clinical condition in severe COVID-19 despite all the therapies. We undertook this retrospective analysis to assess the clinical course and outcome of such patients admitted in an intensive care unit (ICU) of a tertiary care private hospital. Methodology: We retrospectively analyzed data from 26 patients admitted to ICU with severe COVID-19 disease with active CMV infection diagnosed by quantitative polymerase chain reaction between April and November 2020. Data regarding type of underlying co morbidities, severity of illness, ICU course, and outcome were obtained. Results: The mean age was 58.69 years with a predominantly male population (84.6%). Thirteen (50%) patients had underlying immunocompromised condition with diabetes mellitus being the most common seen in 8 (30.76%) patients. The average sequential organ failure assessment (SOFA) and APACHDE II score on admission to ICU were 4.23 and 9.08, respectively. The overall hospital mortality rate for this cohort was 50%. Increased mortality was associated with higher SOFA scores (P = 0.04), higher APACHE II scores (P = 0.04) and in patients administered pulse steroids (P = 0.03). Area under the curve was estimated for mortality prediction was highest (0.982) for SOFA score and the lowest for CMV copies (0.69). There was no association between mortality and number of CMV copies and treatment with anti-CMV therapies. Conclusions: The data give an insight into risk factors, clinical course and outcomes of CMV infection in patients with severe COVID-19 disease. Further studies are required to establish a cause–effect relationship between CMV infection and increased mortality effect of anti-CMV therapies.