Background/Purpose: Both subclinical cytomegalovirus (CMV) viremia and CMV disease have been associated with adverse outcomes in select immunosuppressed populations, including an increased incidence of other infections, prolonged hospitalization, and mortality. We examined the incidence and impact of subclinical CMV viremia in hospitalized patients with systemic autoimmune diseases (AD) [systemic lupus erythematosus (SLE) or anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV)] using the Investigation Use Only (IUO) Abbott RealTimeCMV assay (RT assay).

Methods: Prospectively collected blood samples were obtained from AD hospitalized patients at study entry with a second sample collected 1 week later or at discharge from the hospital, whichever occurred first. Controls included age- and gender- matched inpatients without AD and rheumatology clinic outpatients with vasculitis or SLE without active infection. All plasma samples were tested in batch using the IUO RT assay with a LLOD (LLOQ) at 21 IU/mL (32 IU/mL).

Results:

Twenty-three inpatients (10 SLE, 8 AAV, 5 controls), and 31 outpatient controls were recruited. Detectable CMV viremia by the RT assay was found in 61% (11/18) of inpatient AD subjects, 3% (1/31) of outpatient AD subjects, and in none of the five inpatient controls (p<0.001). Average CMV viremia for AD patients at entry was 51.8 IU/mL (33.1 copies/mL) and at 7 days was 175.3 IU/mL (112.4 copies/mL). CMV IgG titers were similar between controls, AD patients, and AD patients with CMV viremia (2.90 vs. 3.01 vs. 3.75, p=0.54). CMV viremia was associated with increased length of ICU stay (25 vs. 5 days, p=0.033), length of hospital stay (35 vs. 10 days, p=0.014), increased nosocomial infections (7 vs. 1, p=0.007) and trends towards increased frequency of disease flare (3 vs. 0) and renal failure requiring hemodialysis at hospital discharge (4 vs. 1). Two AD patients developed overt CMV disease, neither of which was receiving immunosuppressive therapy at the time of hospitalization. CMV viremia was not associated with the overall severity of illness at study entry (as measured by SOFA and APACHE II scores) nor with disease-specific activity (as measured by SLEDAI or BVAS scores).

Conclusion: More than half of hospitalized AD patients in our cohort had subclinical CMV viremia, which was associated with increased length of hospital stay and nosocomial infections, with trends suggesting a possible impact on disease activity and severity. This low level CMV viremia would be missed by most currently used clinical CMV assays, and occurred even in patients with detectable anti-CMV antibodies. These data suggest that subclinical CMV viremia may wield significant adverse effects in hospitalized patients with SLE and AAV, and that further study of the Immunomodulatory effects of CMV in AD is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-cytomegalovirus-viremia-is-associated-with-increased-nosocomial-infections-and-prolonged-hospitalization-in-patients-with-systemic-autoimmune-diseases/