The Relationship Between CMV* Reactivation and Anti-cytokine Treatment in Critical COVID-19 Patients

Study Overview
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Brief Summary
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The risk of secondary infection is high in critical patients hospitalized with the diagnosis of COVID-19. Immunosuppressive treatments are commonly used in critical COVID-19 patients, and immune dysfunction and CMV reactivation can be unnoticed in these patients.

Detailed Description
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The records of critical patients were reviewed retrospectively. Whether these patients used tocilizumab and/or anakinra and their relationship with CMV reactivation were examined. Furthermore, the relationship between CMV reactivation and mortality and anti-cytokine treatment in patients was also examined. A total of 167 critical COVID-19 patients were included in the study, of which 38 (22.7%) were found to be CMV DNA positive. CMV positivity in patients treated with anti-cytokines (31.11%) was found to be significantly higher than in patients who were not treated with it (16.88%) (p:0.033). There was no significant difference in viral load levels (p:0.513). Furthermore, it was determined that anti-cytokine treatment significantly decreased mortality (p: 0.003) and that there was no significant relationship between CMV reactivation and mortality (p: 0.399). Even though CMV reactivation was high in critical COVID-19 patients who received anti-cytokine treatment, positive developments in morbidity and mortality were observed with early diagnosis and effective treatment.

Official Title
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Department of Infectious Disease and Clinical Microbiology

Conditions
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COVID-19, Cytomegalovirus (CMV), Tocilizumab, Anakinra, Mortality

Intervention / Treatment
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* Diagnostic Test: CMV DNA analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Critically ill patients over the age of 18 diagnosed with COVID-19 and patients followed in the intensive care unit. Exclusion Criteria: Patients under the age of 18 with a mild/moderate course of COVID-19, CMV PCR positive before anti-cytokine treatment, patients who underwent hematopoietic stem cell transplantation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| COVID-19 cases with anticytokine therapy<br>Considering the use of anti-cytokines in these patients, it was found that 53 received tocilizumab, 27 received anakinra, and 10 received both. CMV DNA was positive in 38 (22.7%) of the patients included in the study. CMV positivity was found to be significantly higher in 90 patients (31.11%) compared to 77 patients (16.88%) who did not receive anti-cytokine treatment (p:0.033) | Diagnostic Test: CMV DNA analysis<br>* CMV DNA quantitative viral load levels were studied<br>|
| COVID-19 cases without anticytokine therapy<br>MV positivity was found to be significantly higher in 90 patients (31.11%) compared to 77 patients (16.88%) who did not receive anti-cytokine treatment (p:0.033) | Diagnostic Test: CMV DNA analysis<br>* CMV DNA quantitative viral load levels were studied<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The relationship between CMV reactivation and anti-cytokine treatment | CMV positivity was found to be significantly higher in who receive anti-cytokine treatment | 2020-2021 |