Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study
Abstract Background Cytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. T...
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2025-01-01
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| author | Haruka Ito Takahiko Yoshimoto Akatsuki Kokaze Kuninobu Wakabayashi Kazuteru Noguchi Kiyoshi Matsui Bunki Natsumoto Keishi Fujio Yutaro Hayashi Yuko Kaneko Takahisa Gono Koh Okamoto Shu Okugawa Kyoji Moriya Hirohiko Sueki |
| author_facet | Haruka Ito Takahiko Yoshimoto Akatsuki Kokaze Kuninobu Wakabayashi Kazuteru Noguchi Kiyoshi Matsui Bunki Natsumoto Keishi Fujio Yutaro Hayashi Yuko Kaneko Takahisa Gono Koh Okamoto Shu Okugawa Kyoji Moriya Hirohiko Sueki |
| author_sort | Haruka Ito |
| collection | DOAJ |
| description | Abstract Background Cytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. This study aimed to identify predictors of the onset of CMV infection in patients receiving p-MPSL therapy for connective tissue disease. Methods This was a retrospective, multicenter cohort study. We included patients who received p-MPSL therapy for connective tissue disease and had CMV antigenemia measured between April 2011 and December 2020. Peripheral blood cell data before the start of p-MPSL therapy and at the start of steroid tapering were collected in addition to baseline characteristics, including age, sex, and body mass index. CMV infection was defined as detection of one or more CMV antigen-positive cells (CMV-positive). The study examined and compared the CMV-positive group with the CMV-negative group. Logistic regression analysis was used to explore the factors associated with CMV antigen positivity. Receiver operating characteristic curve analysis was used to identify the cut-off values for the factors associated with CMV antigen sensitivity. Results Of the 200 patients included, 87 had antigen positivity. Logistic regression analysis showed that age ≥ 65 years [adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.54–4.92] and platelet count less than 30.20 × 104 /µL [aOR: 4.38, 95%CI: 2.21–8.68] at baseline were significantly associated with CMV antigen positivity. Lymphocyte count < 1440 /µL [aOR: 5.36, 95% CI: 1.96–14.65], neutrophil-to-lymphocyte ratio (NLR) ≥ 3.42 [aOR: 7.31, 95% CI: 2.52–21.22], and platelet-to-lymphocyte ratio (PLR) ≥ 145.28 [aOR:6.10, 95% CI: 2.24–16.64] at the start of steroid tapering also increased the OR for CMV infection. The areas under the receiver operating characteristic curves for lymphocytes, NLR, and PLR were 0.742, 0.693, and 0.673 respectively. Conclusion Platelet count, lymphocyte count, NLR, and PLR may be crucial predictors of the onset of CMV infection in patients with connective tissue disease. These easily obtainable factors may be clinically useful as predictors of CMV infection. A potential research area would be to validate the parameters in a prospective patient population. |
| format | Article |
| id | doaj-art-7edf1b40c3514cf99ea572d5022b63db |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-7edf1b40c3514cf99ea572d5022b63db2025-02-02T12:10:49ZengBMCBMC Infectious Diseases1471-23342025-01-012511810.1186/s12879-025-10543-zPredictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort studyHaruka Ito0Takahiko Yoshimoto1Akatsuki Kokaze2Kuninobu Wakabayashi3Kazuteru Noguchi4Kiyoshi Matsui5Bunki Natsumoto6Keishi Fujio7Yutaro Hayashi8Yuko Kaneko9Takahisa Gono10Koh Okamoto11Shu Okugawa12Kyoji Moriya13Hirohiko Sueki14Department of Dermatology, Showa University School of MedicineDepartment of Hygiene, Public Health and Preventive Medicine, Showa University Graduate School of MedicineDepartment of Hygiene, Public Health and Preventive Medicine, Showa University Graduate School of MedicineDivision of Rheumatology, Department of Medicine, Showa University School of MedicineDepartment of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of MedicineDepartment of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of MedicineDepartment of Allergy and Rheumatology, Graduate School of Medicine, The University of TokyoDepartment of Allergy and Rheumatology, Graduate School of Medicine, The University of TokyoDivision of Rheumatology, Department of Internal Medicine, Keio University School of MedicineDivision of Rheumatology, Department of Internal Medicine, Keio University School of MedicineDepartment of Allergy and Rheumatology, Nippon Medical School Graduate School of MedicineDepartment of Infectious Disease, The University of TokyoDepartment of Infectious Disease, The University of TokyoDepartment of Infectious Disease, The University of TokyoDepartment of Dermatology, Showa University School of MedicineAbstract Background Cytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. This study aimed to identify predictors of the onset of CMV infection in patients receiving p-MPSL therapy for connective tissue disease. Methods This was a retrospective, multicenter cohort study. We included patients who received p-MPSL therapy for connective tissue disease and had CMV antigenemia measured between April 2011 and December 2020. Peripheral blood cell data before the start of p-MPSL therapy and at the start of steroid tapering were collected in addition to baseline characteristics, including age, sex, and body mass index. CMV infection was defined as detection of one or more CMV antigen-positive cells (CMV-positive). The study examined and compared the CMV-positive group with the CMV-negative group. Logistic regression analysis was used to explore the factors associated with CMV antigen positivity. Receiver operating characteristic curve analysis was used to identify the cut-off values for the factors associated with CMV antigen sensitivity. Results Of the 200 patients included, 87 had antigen positivity. Logistic regression analysis showed that age ≥ 65 years [adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.54–4.92] and platelet count less than 30.20 × 104 /µL [aOR: 4.38, 95%CI: 2.21–8.68] at baseline were significantly associated with CMV antigen positivity. Lymphocyte count < 1440 /µL [aOR: 5.36, 95% CI: 1.96–14.65], neutrophil-to-lymphocyte ratio (NLR) ≥ 3.42 [aOR: 7.31, 95% CI: 2.52–21.22], and platelet-to-lymphocyte ratio (PLR) ≥ 145.28 [aOR:6.10, 95% CI: 2.24–16.64] at the start of steroid tapering also increased the OR for CMV infection. The areas under the receiver operating characteristic curves for lymphocytes, NLR, and PLR were 0.742, 0.693, and 0.673 respectively. Conclusion Platelet count, lymphocyte count, NLR, and PLR may be crucial predictors of the onset of CMV infection in patients with connective tissue disease. These easily obtainable factors may be clinically useful as predictors of CMV infection. A potential research area would be to validate the parameters in a prospective patient population.https://doi.org/10.1186/s12879-025-10543-zCytomegalovirusImmunosuppressionPredictorsPulsed-methylprednisolone therapyImmune reconstitution inflammatory syndrome |
| spellingShingle | Haruka Ito Takahiko Yoshimoto Akatsuki Kokaze Kuninobu Wakabayashi Kazuteru Noguchi Kiyoshi Matsui Bunki Natsumoto Keishi Fujio Yutaro Hayashi Yuko Kaneko Takahisa Gono Koh Okamoto Shu Okugawa Kyoji Moriya Hirohiko Sueki Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study BMC Infectious Diseases Cytomegalovirus Immunosuppression Predictors Pulsed-methylprednisolone therapy Immune reconstitution inflammatory syndrome |
| title | Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study |
| title_full | Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study |
| title_fullStr | Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study |
| title_full_unstemmed | Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study |
| title_short | Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study |
| title_sort | predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy a multicenter retrospective cohort study |
| topic | Cytomegalovirus Immunosuppression Predictors Pulsed-methylprednisolone therapy Immune reconstitution inflammatory syndrome |
| url | https://doi.org/10.1186/s12879-025-10543-z |
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