Background/Purpose: Immunosuppressive therapy, which is frequently used to treat various rheumatic diseases, increases risk of opportunistic infection. However, few reports were available on the prognosis of CMV infection in rheumatic diseases. While prognosis of CMV infection without end-organ involvement is excellent, there is a clinical dilemma to start anti-viral treatment because it is difficult to assess end-organ involvement of CMV due to systemic manifestations of underlying disease or co-existence of other infections. This study aimed to assess the predictors of mortality in rheumatic diseases patients with CMV infection.

Methods:   We retrospectively reviewed the Severance Hospital¡¯s electronic medical records of rheumatic disease patients with CMV infection between 2005 and 2016. Clinical and laboratory data on patients including immunosuppresive treatment, CMV titer by real time PCR, anti-viral treatment were collected. Statistic analysis was done using internet based "R" software. Characterization of the features was analyzed using descriptive statistics and Fisher’s exact test. Separate analyses of variance (Kai analysis) examined. Mortality was compared across the tertiles by CMV titer.

Results:   A total of 68 rheumatic disease patients with CMV infection were evaluated (mean age 56.6 years, 45 women(68%), mean disease duration 6.4 years, 22 deaths). Rheumatic disease¡¯s distribution was like table 1. Mortality rate was significantly higher for the upper tertile CMV group than lower tertile CMV group (table 2, p<0.05). Comparison of the death group and the survival group revealed CMV count (239,252.2 ¡¾ 389,940.3 vs. 63,126.1 ¡¾ 197,791.7, p=0.056), lymphocyte count (917.0 ¡¾ 1,914.6 vs. 682.0 ¡¾ 911.0, P=0.589), using ganciclorvir (10 (45.5%) vs. 15 (32.6%), p=0.448) and using mechanical ventilation (13 (59.1%) vs. 3 ( 6.5%), p<0.0001).

Conclusion: High CMV titer is associated with mortality in rheumatic disease patients even though anti-viral treatment was not associated with mortality. It is still unknown whether high CMV titer is the direct cause of mortality or the result of critical condition. Larger studies are needed to confirm the findings.