ArticleIntensive care medicine2016
Cytomegalovirus reactivation and mortality in patients with acute respiratory distress syndrome.
Article in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05898048 (Cytomegalovirus Reactivation in Acute Necrotizing Pancreatitis), which is not on this map. Cited by 51 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cytomegalovirus Reactivation in Acute Necrotizing Pancreatitis
Who cites it
51 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis.BMC infectious diseases · 2018Pooled it
- Trial
- Viral Reactivation in Immunocompetent Critically Ill Patients.Microorganisms · 2026Review
- Active cytomegalovirus infection in acute respiratory distress syndrome patients: key points requiring attention.Critical care (London, England) · 2026Article
- Histological proof of pulmonary herpesvirus presence in patients with COVID-19- or influenza-related ARDS.Critical care (London, England) · 2026Article
- Metagenomics reveals pathogenic diversity and temporal dynamics in severe pneumonia among patients in adult intensive care unit.BMC infectious diseases · 2026Article
- A machine learning model for accurate prediction of CMV end-organ disease.BMC medical informatics and decision making · 2026Article
- Clinical and biological features of CMV reactivation in ARDS: a prospective cohort study.Critical care (London, England) · 2026Article
- Alveolar dysregulation of host response in pneumonia and ARDS: implications for immune modulation and infection.Annals of intensive care · 2026Review
- Cytomegalovirus Reactivation in Critically Ill Patients With Acute Necrotizing Pancreatitis.Open forum infectious diseases · 2025Article
- The Landscape of lower respiratory tract herpesviruses in severe pneumonia patients: a multicenter, retrospective study with prospective validation.Critical care (London, England) · 2025Article
- Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients.Critical care (London, England) · 2025Article
- What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.Intensive care medicine · 2025Review
- Viral reactivations and fungal infections in nonresolving acute respiratory distress syndrome.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Active cytomegalovirus infection in mechanically ventilated patients with sepsis.BMC infectious diseases · 2024Article
- The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review.Pathogens (Basel, Switzerland) · 2024Review
- Pulmonary herpes simplex virus and cytomegalovirus in patients with acute respiratory distress syndrome related to COVID-19.Intensive care medicine · 2024Observational
- Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study.Critical care (London, England) · 2024Observational
- Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective.World journal of virology · 2024Review
- The Impact of Pathogens on Sepsis Prevalence and Outcome.Pathogens (Basel, Switzerland) · 2024Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeCytomegalovirus (CMV) reactivation occurs frequently in patients with the acute respiratory distress syndrome (ARDS) and has been associated with increased mortality. However, it remains unknown whether this association represents an independent risk for poor outcome. We aimed to estimate the attributable effect of CMV reactivation on mortality in immunocompetent ARDS patients.
methodsWe prospectively studied immunocompetent ARDS patients who tested seropositive for CMV and remained mechanically ventilated beyond day 4 in two tertiary intensive care units in the Netherlands from 2011 to 2013. CMV loads were determined in plasma weekly. Competing risks Cox regression was used with CMV reactivation status as a time-dependent exposure variable. Subsequently, in sensitivity analyses we adjusted for the evolution of disease severity until onset of reactivation using marginal structural modeling.
resultsOf 399 ARDS patients, 271 (68%) were CMV seropositive and reactivation occurred in 74 (27%) of them. After adjustment for confounding and competing risks, CMV reactivation was associated with overall increased ICU mortality (adjusted subdistribution hazard ratio (SHR) 2.74, 95% CI 1.51-4.97), which resulted from the joint action of trends toward an increased mortality rate (direct effect; cause specific hazard ratio (HR) 1.58, 95% CI 0.86-2.90) and a reduced successful weaning rate (indirect effect; cause specific HR 0.83, 95% CI 0.58-1.18). These associations remained in sensitivity analyses. The population-attributable fraction of ICU mortality was 23% (95% CI 6-41) by day 30 (risk difference 4.4, 95% CI 1.1-7.9).
conclusionCMV reactivation is independently associated with increased case fatality in immunocompetent ARDS patients who are CMV seropositive.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.