Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective

Table 1 Risk factors for cytomegalovirus reactivation

Risk factors for CMV reactivation	Ref.	Statistics
High disease severity	Kalil et al[1]	High disease severity (APACHE > 20, SAPS > 40 or SOFA > 10) 32% vs low disease severity (APACHE < 20, SAPS < 40 or SOFA < 10) 13% (P < 0.0001)
	Ong et al[10]	Mean APACHE IV 91 (71-113) vs 76 (62-99) (P < 0.01)
Prolonged ICU stay	Kalil et al[1]	1% < 5 d vs 21% at > 5 d (P < 0.001)
	von Müller et al[11]	32% by day 14
	Limaye et al[2]	33% by day 12
Sepsis, septic shock	Kalil et al[1]	Reactivation of CMV in patients with and without septic shock: 32% vs 15% (P < 0.0001)
	Osawa et al[12]	OR 4.62 (P = 0.02)
	Ong et al[10]	Reactivation of CMV in patients with and without septic shock 57% vs 41% (P = 0.02)
Previous seropositivity	Kalil et al[1]	Reactivation of CMV in patients with and without previous seropositivity for CMV: 31% vs 7% (P < 0.0001)
Mechanical ventilation	Osawa et al[12]	OR: 8.5 (95%CI 1.1 to 66.5 for high-grade CMV viremia, i.e. CMV PCR > 1000 copies/mL)
	Limaye et al[2]	OR 2.5 (0.9-7.3) (P = 0.09)
Multiple blood transfusions	Frantzeskaki et al[9]	OR 1.50 (P = 0.02)
	Chiche et al[13]	OR 3.31 (P = 0.04)
	Limaye et al[2]	OR 9.1 (1.0-84.7) (P = 0.05)
Surgical patients	Kalil et al[1]	Rate of CMV reactivation in medical ICUs: 8% vs surgical ICUs: 23% (P < 0.001)
Steroid use	Jaber et al[14]	CMV reactivation in patients with and without steroid use: 55% vs 33% (P = 0.04)
	Chiche et al[13]	OR 2.26 (P = 0.08)
Renal failure	Jaber et al[14]	58% vs 33% (P = 0.02)
	Ong et al[10]	16% vs 6% (P < 0.01)
Male	Limaye et al[2]	OR 3.6 (P = 0.005)
Raised CRP	Frantzeskaki et al[9]	OR 1.01 (P = 0.02)

CMV: Cytomegalovirus; APACHE: Acute physiology and chronic health evaluation; SAPS: Simplified acute physiology score; SOFA: Sequential organ failure assessment; ICU: Intensive care unit; OR: Odd’s ratio, PCR: Polymerase chain reaction; CRP: C-reactive protein.