Active Cytomegalovirus Infection in Acute Respiratory Distress Syndrome Patients: Incidence, Risk Factors, and Clinical Outcomes

Abstract Background: Acute respiratory distress syndrome (ARDS) patients have been reported to have a high seroprevalence of cytomegalovirus (CMV). However, the role of active CMV infection in ARDS patients has not been clearly established.Objective: This study aimed at determining the incidence, risk factors, and clinical outcomes of active cytomegalovirus (CMV) infection in acute respiratory distress syndrome (ARDS) patients.Methods: We retrospectively reviewed medical records for ARDS patients who had been admitted to the intensive care unit (ICU) from January 1st, 2018 to December 31st, 2020 at a national teaching hospital in China. Study participants were divided into active CMV infection and non-active infection groups based on CMV DNAemia within a 28-day hospitalization period in ICU. Clinical features, laboratory findings, treatment measures, and clinical outcomes were compared between the two groups.Results: Among 168 ARDS patients, 31 (18.5%) exhibited active CMV infection within the 28-day hospitalization period in ICU. In multivariate logistic regression analysis, monocyte counts, hemoglobin levels, blood transfusion, and septic shock were significantly independently associated with active CMV infection (p < 0.05). Oxygenation (PaO2/FiO2) of active CMV infection patients was worse than for non-active CMV infection (p < 0.05). Duration of invasive mechanical ventilation, 28-day ventilator-free days, length of ICU stay, and 28-day all-cause mortality rates in active CMV infection patients were significantly higher than in those without active CMV infection (p < 0.05).Conclusions: Active CMV infection is common among critically ill ARDS patients. Monocytes, hemoglobin, blood transfusion, and septic shock are risk factors for active CMV infection, which has a negative effect on oxygenation. Moreover, active CMV infection is associated with several adverse prognoses. Prospective studies should be performed to evaluate the impact of prophylactic antiviral therapy for prognoses among ARDS patients.