Clinical Analysis Of Severe Cytomegalovirus Pneumonia In Immunocompromised Hosts With Non-HIV Infection

ObjectiveTo explore the clinical features and prognostic risk factors of severe cytomegalovirus pneumonia in immunocompromised hosts without human immunodeficiency virus(HIV)infection.MethodsA retrospective study collected and analyzed the clinical data of 64 non-HIV-infected immunocompromised patients diagnosed with severe cytomegalovirus pneumonia between December 2018 and December 2021.Collected gender,age,underlying disease,blood routine test(BRT),procalcitonin(PCT),C-reactive protein(CRP),lactate dehydrogenase(LDH),T lymphocyte subsets,and blood gas analysis(BG).Disease severity was scored using the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,the Pneumonia Severity Index(PSI),and the CURB-65(Confusion,Disease severity scores such as Urea,Respiratory rate,and Age65).The patients were divided into a survival group and a death group according to the 28-day outcome after discharge from hospital.The data were analyzed with the SPSS(version 23.0)statistical package.Results1.A total of 64 non-HIV-infected immunocompromised patients with severe cytomegalovirus pneumonia were included,including 33(51.6%)males and 31(48.4%)females,aged(55.1±14.4)years old.There were 34 cases in the survival group,with an average age of(53.9±13.9)years,21(61.8%)males and 13(38.2%)females.30 cases in the death group,with an average age of(56.4±15.1)years,and 12(40.0%)males,and 18(60.0%)females.There were no significant differences in gender and age between the two groups(both P>0.05).2.The underlying diseases related to low immune function were immune connective tissue diseases(23,35.9%),renal diseases(17,26.6%),hematological malignancies(11,17.2%),and solid malignancies(5,7.8%).In total,43(67.2%)patients received glucocorticoid therapy and 31(48.4%)received immunosuppressive therapy.3.The main clinical symptoms were fever(41,64.1%),cough(29,45.3%),chest tightness(25,39.1%),dyspnea(21,32.8%),and expectoration(20,31.3%).Chest pain was present in 4 patients(6.25%).The main imaging features of the chest were:diffuse ground-glass opacity in the double lung(40,62.5%),patchy increased density in the double lung(31,48.4%),nodular opacity(24,37.5%),mediastinal lymphadenopathy(17,26.6%),grid shadows(12,18.8%),consolidation shadows(8,12.5%),and cavity(8,12.5%).4.The APACHE II,PSI,and CURB-65 in the death group were(23.2±1.2),(140.7± 5.3),2.0(2.0,3.0),which were higher than those in the survival group(18.1±1.2),(115.2± 6.9),1.0(1.0,2.0)(all P<0.05).AUROC of APACHE Ⅱ score,PSI score classification and CURB-65 score were 0.722(%95 CI:0.595-0.826),0.678(%95 CI:0.550-0.790),0.774(%95 CI:0.652-0.869)(all P<0.05).5.The lymphocyte counts in the blood routine of both groups were low,and the death group was 0.5(0.3,0.8)×109/L,which was significantly lower than the survival group 0.9(0.4,1.7)×l09/L(P<0.05).T lymphocyte subsets(CD3+T lymphocytes,CD4+T lymphocytes,CD4+/CD8+T lymphocyte)in the death group were 351.3(218.0,536.6),116.5(76.4,190.5),and 0.6(0.4,1.0),the survival group were 622.0(329.1,1031.7),282.0(138.8,427.0),1.0(0.7,1.8)(all P<0.05).LDH of the two groups were higher than the normal range,and the death group was 1079.5(816.0,1666.3)U/L significantly higher than the survival group 553.0(400.0,822.5)U/L(P<0.05).There was no significant statistical significance in neutrophil count,PCT,CRP,ESR and other inflammatory indicators(all P>0.05).6.The mortality of 64 patients was 46.9%.The incidence rates of respiratory failure,multiple organ failure syndromes,and ARDS in the death group were all higher than those in the survival group(all P<0.05).The oxygenation index of both groups decreased obviously,the death group was 88.7(57.1,135.1)significantly lower than the survival group 172.6(104.3,205.2)(P<0.05).The proportion of mechanically ventilated patients in the death group(86.7%)was significantly higher than that in the survival group(20.6%)(P<0.05).17(56.7%)patients in the death group were treated with vasoactive drugs,which was much higher than that in the 7(20.6%)patients in the survival group(P<0.05).The length of hospital stay in the death group was(18.2±14.0)significantly shorter than that in the survival group(29.6±20.9)days(P<0.05).7.Multivariate logistic regression analysis showed that CURB-65,LDH were independent risk factors for the patients(OR=2.883,1.002,P<0.05).Conclusions1.Non-HIV-infected immunocompromised hosts with severe cytomegalovirus pneumonia are critically ill and have a high mortality rate.2.Non-HIV-infected immunocompromised hosts with severe cytomegalovirus pneumonia who have decreased lymphocyte counts and CD4+T lymphocytes,are at high risk of death.3.APACHE Ⅱ,PSI and CURB-65 scores have predictive value for the prognosis of severe cytomegalovirus pneumonia in non-HIV-infected immunocompromised hosts.CURB-65 and LDH are independent risk factors associated with the prognosis of the patients.