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Predictors of mortality in autoimmune disease patients with concurrent cytomegalovirus infections detected by quantitative real-time PCR.

Authors
 Kyoung Yong Lee  ;  Byung-Woo Yoo  ;  Sung Soo Ahn  ;  William Han Bae  ;  Hyukmin Lee  ;  Seung Min Jung  ;  Sang-Won Lee  ;  Yong-Beom Park  ;  Jason Jungsik Song 
Citation
 PLoS One, Vol.12(7) : e0181590, 2017 
Journal Title
 PLoS One 
Issue Date
2017
MeSH
Adult ; Aged ; Antiviral Agents/therapeutic use ; Autoimmune Diseases/complications ; Autoimmune Diseases/drug therapy ; Autoimmune Diseases/mortality ; Autoimmune Diseases/virology ; Cytomegalovirus/drug effects ; Cytomegalovirus/genetics ; Cytomegalovirus/isolation & purification ; Cytomegalovirus Infections/complications ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/drug therapy ; DNA, Viral/analysis ; DNA, Viral/genetics ; Female ; Ganciclovir/therapeutic use ; Hospital Mortality ; Humans ; Immunosuppressive Agents/therapeutic use ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Risk Factors
Abstract
OBJECTIVE: Cytomegaloviruses (CMV) can have a significant impact on the prognosis of immunocompromised patients. Unlike in the transplantation and AIDS fields, only a few studies on CMV infections have been published in the field of autoimmunity. In this study, we examined the clinical outcomes of CMV infections in patients with autoimmune diseases at a single tertiary medical institution. METHODS: A retrospective study was performed to identify the mortality risk factors associated with CMV infections in patients with autoimmune diseases. We reviewed the medical records of patients with autoimmune diseases who were diagnosed with CMV infections using real-time quantitative polymerase chain reaction between December 2005 and March 2016. Clinical and laboratory parameters as well as treatment outcomes were analyzed. RESULTS: Seventy-three CMV infected patients were separated into survivors and non-survivors. Non-survivors had significantly higher median CMV-DNA copy numbers than survivors (95,500 vs 6,700 copies/mL, p = 0.005) and demonstrated significantly more frequent incidents of CMV pneumonitis (69.2 vs 36.2%, p = 0.007). After adjusting for multiple confounding covariates, the log CMV-DNA copies/mL (hazard ratio, 1.48; 95% confidence interval, 1.14-1.92; p = 0.003) and the presence of concurrent infections (hazard ratio, 22.00; 95% confidence interval, 2.75-175.97, p = 0.004) were identified as independent mortality risk factors. Furthermore, patients with high CMV copy numbers (> 60,000 copies/mL) had higher in-hospital mortality than those with low CMV copy numbers (p < 0.05). CONCLUSIONS: CMV-DNA copy numbers and concurrent infections are predictors of in-hospital mortality in CMV-infected patients with autoimmune diseases. Therefore, serial measurements of CMV-DNA copy numbers and close observation for signs of other infections are recommended for patients with autoimmune diseases who have concurrent CMV infection
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DOI
10.1371/journal.pone.0181590
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
박용범(Park, Yong Beom)
송정식(Song, Jungsik Jason) ORCID logo https://orcid.org/0000-0003-0662-7704
안성수(Ahn, Sung Soo) ORCID logo https://orcid.org/0000-0002-9002-9880
이경용(Lee, Kyoung Yong)
이상원(Lee, Sang Won) ORCID logo https://orcid.org/0000-0002-8038-3341
이혁민(Lee, Hyuk Min) ORCID logo https://orcid.org/0000-0002-8523-4126
정승민(Jung, Seung Min ) ORCID logo https://orcid.org/0000-0003-3465-2181
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160557
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