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

 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 
 PLOS ONE, Vol.12(7) : e0181590, 2017 
Journal Title
Issue Date
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
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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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
Park, Yong Beom(박용범)
Song, Jason Jungsik(송정식) ORCID logo https://orcid.org/0000-0003-0662-7704
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-9002-9880
Lee, Kyoung Yong(이경용)
Lee, Sang-Won(이상원) ORCID logo https://orcid.org/0000-0002-8038-3341
Lee, Hyuk Min(이혁민) ORCID logo https://orcid.org/0000-0002-8523-4126
Jung, Seung Min (정승민) ORCID logo https://orcid.org/0000-0003-3465-2181
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