Clinical characteristics and associated risk factors of cytomegalovirus infection in patients with underlying systemic Rheumatic diseases

Abstract

Objective: To retrospectively investigate the clinical characteristics, risk factors of Cytomegalovirus (CMV) infection in patients with underlying rheumatic diseases. Methods: Clinical records of 263 rheumatic patients with or without CMV infection, hospitalized from March 2011 to June 2014 in Peking University People's Hospital, were analyzed.Clinical characteristics were summarized and compared in CMV positive and negative groups, to investigate the risk factors for CMV infection.Statistical analyses were conducted with SPSS 20.0 software. Results: A total of 62 rheumatic patients were found to have CMV infection, with 48 regarded as CMV viremia, 7 diagnosed as CMV pneumonia, while the remaining 7 suffered both CMV viremia and pneumonia.Eleven of 62 patients (17.7%) had a fatal outcome.Systemic lupus erythematosus (SLE) was the most commonly underlying disease (41.9%), followed by Sjögren syndrome (16.1%) and systemic vasculitis (12.9%). Lymphopenia and the reduction of CD4+ T lymphocytes, corticosteroids, cyclophosphamide (CTX) or mycophenolate mofetil (MMF), combined use of more than 2 immunosuppressants and other severe underlying infections as risk factors for CMV infection in rheumatic patients.Meanwhile, the total dose of CTX wasn't different significantly between CMV positive and negative groups.Multivariate analysis revealed that large or pulsed dose of corticosteroids, combined use of immunosuppressants, and severe underlying infections remained independent risk factors for CMV infection. Conclusions: Lymphocytes, particularly the CD4+ T subsets, might play a vital role in the regulation and control of CMV infection.Other underlying infections, undergoing large dose corticosteroids therapy or combined use of immunosuppressants could be the risk factors for CMV infection in rheumatic patients.