Respiratory failure & ventilation
Clinical and biological features of cytomegalovirus (CMV) reactivation in acute respiratory distress syndrome (ARDS): a prospective cohort study
Authors' conclusion
Patients with CMV reactivation exhibited a significantly poor clinical prognosis.
Study context
- Population
- ARDS patients assessed for CMV reactivation upon ICU admission151 plasma, 48 bronchoalveolar lavage fluid (BALF) samples analysed
- Participants
- 151 patients
- Exposure
- CMV reactivation vs no CMV reactivation
- CMV reactivationn = 47
- Outcome
- 90-day mortality
- Follow-up
- 90 days
Methodological detailsmultivariate and time-dependent Cox regression, proteomic and metabolomic analyses
- Multivariate and time-dependent Cox regression
- Proteomic and metabolomic analyses
Main finding
As reported in the abstract
CMV reactivation vs No CMV reactivationEstimate (95% CI)P value
90-day mortality
HR 2.09(1.12–3.90)
P = 0.018Multivariate regression
aHR 1.97(1.04–3.74)
P = 0.037Time-dependent Cox regression
time-adjusted HR 2.61(1.38–4.94)
P = 0.003Observational data: associations, not effects.
Further findings
| Outcome | MD (95% CI) | P value | |
|---|---|---|---|
| ICU LOSRemained significant after regression adjustment | 16.22 (8.36–24.09) | P = 0.006 | |
| −100102030Difference (linear scale) |
| Outcome | MD (95% CI) | P value |
|---|---|---|
| Ventilator-free daysRemained significant after regression adjustment | - 12.48 (- 17.75 to - 7.22) | P < 0.001 |
- CMV reactivation incidence · 90 days
- 31.1% · 47
- CMV reactivation incidence: 47/151
90-day mortality, pulmonary reactivation (subgroup)
- Pulmonary reactivation had a higher risk of mortality
Biomarkers correlated with increased mortality
- CXCL5 in BALF, Corr. (P = 0.038)
- 0.301
- DERPC in BALF, Corr. (P = 0.030)
- −0.314
- PTX3 in blood, Corr. (P < 0.001)
- 0.291
Proteomic and metabolomic analyses
- Suppression of immune, complement and ribosomal subunit biogenesis pathways in BALF, activation of immune responses in plasma with CMV reactivation
- Upregulation of tryptophan metabolism in plasma and pyrimidine metabolism in BALF with CMV reactivation
Original publication
Clinical and biological features of CMV reactivation in ARDS: a prospective cohort study. Crit Care. Published 6 January 2026. doi:10.
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