Analysis of clinical features and risk factors of in-hospital mortality in cytomegalovirus (CMV) diseases with systemic lupus erythematosus

Background: Cytomegalovirus (CMV) is known as a major cause for life-threatening complications in immunocompromised hosts, including status post allogeneic bone marrow transplantation, solid organ transplantations, and acquired immunodeficiency syndrome (AIDS). The reactivation of CMV depends on the immune status of host. Systemic lupus Erythematosus (SLE) often requiressteroid and immunosuppressive agents to induce remission and lower disease activity. This study presents the clinical presentations, laboratory characteristics, medical profile (including steroid, immunosuppressive agents, and biological agents) and clinical outcomes in SLE patients with diagnosis of CMV diseases. Further, we attempted to investigate the mortality risk factor in these patients. Objectives: To analyse the clinical features, the mortality risk factors and all-cause mortality of Cytomegalovirus (CMV) diseases in patients with systemiclupus erythematosus (SLE) in single centre of Taiwan. Methods: A retrospective study was performed to investigate the clinical features and identify the mortality risk factors associated with CMV diseases in patients with systemic lupuserythematosus (SLE). We reviewed the medical records in patients with SLE who were diagnosed with CMV diseases between Jan. 2006 and Dec. 2016 fromTaipei Veterans General Hospital in Taiwan. Clinical and laboratory parameters as well as treatment outcomes were analysed. Results: Fifty-six patients diagnosed with CMV diseases were enrolled in the study and separated into survivors(n=24) and non-survivors (n=32) groups. All patients in CMV disease demonstrated significantly high incidence of CMV pneumonitis (71.43%). The higher SLEDAI-2000 score (p=0.009, HR1.154, 95% CI 1.037–1.285), percentage of recent pulse therapy (p=0.013, HR 4.569, 95% CI 1.313–15.902), and plasmapheresis during hospital course (p=0.005, HR6.905, 95% CI 1.637–29.122) was more common characteristics in non-survivor group than in survivor group. Non-survivors had significantly higher percentage of pancytopenia (p=0.001, HR9.667, 95% CI 2.307–40.511), CMV-positive PCR of blood and bronchoalveolar(BAL) lavage fluid (Blood: p<0.001, HR 15.000, 95% CI 3.932–57.223, BAL fluid: p=0.021, HR 6.176, 95% CI 1.151–33.151), and presence of concurrent infections(bacteremia: p=0.026, HR 4.833, 95% CI 1.122–20.824, other fungal infections:p<0.001, HR 11.424, 95% CI 2.722–47.952) than survivors. Septic shock (n=10, 41.2% of non-survivor group) is the most common cause of in-hospital mortality in CMV diseases. Conclusions: The recent pulse therapy, pancytopenia, and concurrent infections are risk factors of in-hospital mortality in CMV diseases of patients with Systemic Lupus Erythematosus. The serological data of non-survivor groups showed negative findings of CMV immunoglobulin M (IgM) with detection of CMV DNA by polymerase chain reaction (PCR) was observed in CMV diseases. The pulmonary haemorrhage and acute respiratory distress syndromes (ARDS) were the factors of in-hospital mortality in CMV pneumonitis. References: N Berman and HM Belmont Disseminated cytomegalovirus infection complicating active treatment of systemic lupus erythematosus: an emerging problem. Lupus. 2017 Apr;26(4):431–434. DOI:10.1177/0961203316671817 Tsai WP, Chen MH, Lee MH, Yu KH, Wu MW, Liou LB. Cytomegalovirus infection causes morbidity and mortality in patients with autoimmune diseases, particularly systemic lupus: in a Chinese population in Taiwan. Rheumatology international. 2012; 32(9):2901–8. DOI:10.1007/s00296–011–2131–4 Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2018-eular.1063 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1441Session: SLE, Sjögren’s and APS – clinical aspects (other than treatment)