The relationship between CMV reactivation, anti-cytokine treatment and mortality in critical COVID-19 patients

Ramazan Gozukucuk; Hasan Huseyin  KILIC

doi:10.12669/pjms.39.5.7301

Ramazan Gozukucuk Istanbul Galata Universty
Hasan Huseyin KILIC Istanbul Dogus Universty, Hisar Hospital Intercontinental https://orcid.org/0000-0002-9639-6307

DOI: https://doi.org/10.12669/pjms.39.5.7301

Keywords: Tocilizumab, Anakinra, Anti-cytokine treatment, Mortality, Cytomegalovirus (CMV), COVID-19

Abstract

Objective: To examine the use of anti-cytokine treatment in critical COVID-19 patients and their association with the frequency of CMV cases, viral load level, and mortality in these patients.

Methods: This is a retrospective study. A total of 170 critical and/or intensive care patients with COVID-19 admitted to Hisar Hospital Intercontinental from March 15, 2020, to December 31, 2021 were divided into the use of anti-cytokine treatment group and the no anti-cytokine treatment group. Furthermore, the relationship between CMV reactivation, mortality and anti-cytokine treatment in patients was also examined.

Results: A total of 170 critical COVID-19 patients were included in the study, three of them were excluded. One hundred sixty seven were included in the study of which 38 (22.7%) were found to be CMV DNA positive. As an anti-cytokine treatment, it was observed that tocilizumab was used in 53 patients, anakinra was used in 27 patients, and no anti-cytokine treatment was used in 77 patients. CMV positivity in patients treated with anti-cytokines (31.11%) was found to be significantly higher than in patients who were not treated with it (16.88%) (p:0.033). Furthermore, it was determined that anti-cytokine treatment significantly decreased mortality (p: 0.003) and that there was no significant relationship between CMV reactivation and mortality (p: 0.399).

Conclusion: Even though CMV reactivation was high in critical COVID-19 patients who received anti-cytokine treatment, decrease in mortality were observed with early diagnosis and effective treatment. Therefore, CMV infection should be considered in patients receiving immunosuppressive treatment.

Clinical Trial Registration: HisarIH-101/NCT05419206

doi: https://doi.org/10.12669/pjms.39.5.7301

How to cite this: Gozukucuk R, Kilic HH. The relationship between CMV reactivation, anti-cytokine treatment and mortality in critical COVID-19 patients. Pak J Med Sci. 2023;39(5):1286-1290. doi: https://doi.org/10.12669/pjms.39.5.7301

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.