Outcomes of Cytomegalovirus Viremia Treatment in Critically Ill Patients with COVID-19 Infection

Background Patients with COVID-19 admitted to the intensive care unit (ICU) have poor outcomes and frequently develop comorbid conditions, including cytomegalovirus (CMV) reactivation. The implications of CMV reactivation in this setting are unknown. We aimed to investigate if treatment of CMV viremia improved in-hospital mortality in ICU patients with COVID-19. Methods In this single center retrospective study, we analyzed clinical outcomes in patients diagnosed with COVID-19 pneumonia and CMV viremia admitted to an ICU from March 1, 2020, to April 30, 2021, who either received treatment (ganciclovir and/or valganciclovir) or no treatment. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were total hospital length of stay (LOS), ICU LOS, requirement for extracorporeal membrane oxygenation (ECMO) support, duration of mechanical ventilation (MV), and predictors of in-hospital mortality. Results A total of 80 patients were included, 43 patients in the treatment group and 37 in the control. Baseline characteristics were similar in both groups. CMV-treated patients were more likely to test positive for CMV earlier in their course, more likely to be on ECMO and received higher total steroid doses on average. In-hospital mortality was similar between the two groups (37.2% vs 43.2.0% p-value = 0.749). There was no significant difference in hospital LOS, though CMV-treated patients had a longer ICU LOS. Conclusions Treatment of CMV viremia did not decrease in-hospital mortality in ICU patients with COVID-19, but sample size was limited. CMV viremia was significantly associated with total steroid dose received and longer ICU stay.

Automated summary

Treatment of CMV viremia did not decrease in-hospital mortality in ICU patients with COVID-19, but sample size was limited. CMV viremia was significantly associated with total steroid dose received and longer ICU stay.