Cytomegalovirus infection in intensive care unit patients with hematological malignancies: Characteristics and clinical outcomes.

BACKGROUND: Cytomegalovirus (CMV) infection is associated with poor outcome in ICU patients. However, data on immunocompromised patients are scarce. This study aims to describe characteristics and outcomes of critically ill hematological patients and CMV infection. CMV disease characteristics and relationship between CMV viral load, CMV disease, coinfections by other pathogens and outcomes are described. METHODS: Retrospective single center study (Jan 2010-Dec 2017). Adult patients, admitted to the ICU, having underlying hematological malignancy and CMV infection were included. Results are reported as median (interquartile) or n (%). Factors associated with hospital mortality or CMV disease were analysed using logistic regression. RESULTS: 178 patients were included (median age 55y [42-64], 69.1% male). Hospital mortality was 53% (n = 95). Median viral load was 2.7 Log [2.3-3.5]. CMV disease occurred in 44 (24.7%) patients. Coinfections concerned 159 patients (89.3%). After adjustment for confounders, need for vasopressors (OR 2.53; 95%CI 1.11-5.97) and viral load (OR 1.88 per Log; 95%CI 1.29-2.85) were associated with hospital mortality. However, neither CMV disease nor treatment were associated with outcomes. Allogeneic stem cell transplantation (OR 2.55; 95%CI 1.05-6.16), mechanical ventilation (OR 4.11; OR 1.77-10.54) and viral load (OR 1.77 per Log; 95%CI 1.23-2.61) were independently associated with CMV disease. Coinfections were not associated with CMV disease or hospital mortality. CONCLUSION: In critically-ill hematological patients, CMV viral load is independently associated with hospital mortality. Conversely, neither CMV disease nor treatment was associated with outcome suggesting viral load to be a surrogate for immune status rather than a cause of poor outcome.

Evidence that glutathione is the unidentified amine (Unk 2.5) released by high potassium into cochlear fluids.

An unidentified substance, Unk 2.5, may be important in the function of the cochlea. The efflux of Unk 2.5 into cochlear fluids is increased by intense sound (Bobbin and Fallon, 1992) and by exposure of the cochlear tissue to high concentrations of K+ (Bobbin et al., 1990,1991; Bobbin and Fallon, 1992). The unidentified chemical eluted at 2.5 min in chromatograms obtained by HPLC utilizing fluorescence detection and precolumn o-phthalaldehyde (OPA) derivatization of samples of effluent from the cochlea (e.g., Bobbin et al., 1990). The purpose of this investigation was to provide evidence as to the identity of this unidentified chemical we call Unk 2.5. Therefore, we carried out additional HPLC assays on samples obtained during perfusion of the cochlear perilymph compartment. Glutathione (GSH) was found to elute at the same time (@ 2.5 min) as Unk 2.5 in HPLC chromatograms utilizing precolumn derivatization with OPA and mercaptoethanol. In addition, both Unk 2.5 and GSH reacted with OPA without mercaptoethanol present in the reaction mixture to give a peak at 2.5 min in the chromatogram, but failed to show this peak if stored in solutions with a pH > 7 for several days before the reaction. Results indicate that Unk 2.5 is GSH or a closely related compound. Given this probable identification GSH, aka Unk 2.5, has been demonstrated to be released from tissue in the cochlea by high concentrations of K+ (Bobbin et al., 1990,1991) and by intense sound (124 dB SPL; Bobbin and Fallon, 1992).