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Erschienen in:
01.01.2016 | Original
Interferon-γ production by CMV-specific CD8+ T lymphocytes provides protection against cytomegalovirus reactivation in critically ill patients
Erschienen in: Intensive Care Medicine | Ausgabe 1/2016
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Purpose
To evaluate the usefulness of the secretion of interferon-γ (IFNγ) by cytomegalovirus (CMV)-specific CD8+ T cells to determine the risk of CMV reactivation in critically ill non-immunosuppressed patients.
Methods
Two-center prospective cohort study including critically ill non-immunosuppressed CMV-seropositive patients admitted between December 2012 and March 2013. The incidence of CMV reactivation by polymerase chain reaction (real-time PCR) in plasma was investigated. IFNγ secretion by CMV-specific
CD8+ T lymphocytes was determined at the time of admission to the intensive care unit (ICU) by means of the QuantiFERON®-CMV (QF-CMV) test. Cox regression analyses were performed to investigate CMV reactivation risk factors.
Results
Fifty-three patients were included, of whom 13 (24.5 %) presented CMV reactivation. Twenty-six patients (49.1 %) were QF-CMV “reactive” (QF-CMVR). Of the 26 QF-CMVR patients, 11.5 % (3/26) had CMV reactivation, whereas 37 % (10/27) of QF-CMV “non reactive” patients (QF-CMVNR) presented reactivation (p = 0.03). By Cox regression, the presence of QF-CMVR at ICU admission (HR 0.09, 95 % CI 0.02–0.44; p = 0.003) was associated with a decreased risk of CMV reactivation. The sensitivity, specificity, positive predictive value, and negative predictive value of QF-CMV were 77, 57, 37, and 88 %, respectively. Eleven of the 53 patients (20.7 %) died during the follow-up period. Mortality was more frequent in patients with CMV reactivation (6/13, 46.1 vs. 5/40, 12.5 %; p = 0.015).
Conclusions
In critically ill non-immunosuppressed patients, the presence of functional CMV-specific CD8+ T lymphocyte response at intensive care unit admission provides protection against CMV reactivation.