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Subclinical CMV viremia is associated with increased nosocomial infections and prolonged hospitalization in patients with systemic autoimmune diseases

Maksimowicz-McKinnon, Kathleen (2018) Subclinical CMV viremia is associated with increased nosocomial infections and prolonged hospitalization in patients with systemic autoimmune diseases. Master Essay, University of Pittsburgh.

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Abstract

Background: Subclinical cytomegalovirus (CMV) viremia is associated with adverse outcomes in select immunosuppressed populations, including 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 new Abbott RealTime CMV assay (RT assay).
Methods: Prospectively collected blood samples were obtained from AD hospitalized patients at study entry and 1 week later or at discharge from the hospital. All samples were tested in batch using the 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 was found in 61% (11/18) of inpatient AD subjects, 3% (1/31) of outpatient AD subjects, and no 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 viremia was associated with increased ICU stay (25 vs. 5 days, p=0.033), hospital stay (35 vs. 10 days, p=0.014) and nosocomial infections (7 vs. 1, p=0.007). CMV viremia was not associated with overall severity of illness at entry nor disease activity or damage.
Conclusions/Public Health Relevance: Over half of hospitalized AD patients in our cohort had detectable CMV viremia, which was associated with increased length of hospital stay and nosocomial infections. These data suggest that subclinical CMV viremia may wield significant adverse effects in hospitalized patients with SLE and AAV, and be a potentially modifiable risk factor to improve outcomes in this population.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Maksimowicz-McKinnon, Kathleenkmaxdo@hotmail.comkam4470000-0001-8839-9906
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairGlynn, Nancyglynn@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberRinaldo, Charlesrinaldo@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberAlangaden, Georgegalaga1@hfhs.orgUNSPECIFIEDUNSPECIFIED
Date: 24 April 2018
Date Type: Submission
Submission Date: 23 April 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 42
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: cytomegalovirus, autoimmune disease, systemic lupus erythematosus, ANCA-associated vasculitis
Date Deposited: 14 Aug 2019 13:55
Last Modified: 14 Aug 2019 13:55
URI: http://d-scholarship.pitt.edu/id/eprint/34380

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