Investigators have identified potentially useful markers for predicting cytomegalovirus (CMV) viremia and infection following induction of immunosuppressive therapy in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, according to a recent report. These include total protein, hemoglobin, and platelet and lymphocyte count.
Makoto Harada, MD, of Shinshu University School of Medicine in Matsumoto, Japan, and colleagues conducted a single-center, retrospective, observational study of 35 patients with newly diagnosed ANCA-associated vasculitis. Of 25 patients who underwent a CMV antigenemia test, 15 (60%) were diagnosed with CMV viremia, the investigators reported in the Journal of Clinical Medicine. CMV infection developed in 5 of them. The total protein, hemoglobin, platelet count, and lymphocyte count at the time of the antigenemia test were significantly lower among patients who experienced CMV viremia compared with those who did not: median 5.2 vs 5.8 g/dL, 9.0 vs 10.6 g/dL, 12.9 vs 20.0 ×104/µL, and 673 vs 1142/µL, respectively.
The cutoff values for predicting CMV viremia for total protein, hemoglobin, platelet count, and lymphocyte count were 5.5 g/dL, 9.0 g/dL, 14.6 × 104/µL, and 750/µL, respectively, Dr Harada’s group reported.
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Of the 15 patients with CMV viremia, 7 patients received ganciclovir or valganciclovir and 5 did not require treatment. Prednisolone dose was lowered for 5 patients. All patients recovered, according to the investigators.
The study was limited by its single-center, retrospective, observational design and a small sample size that did not allow for multivariate analyses. In addition, the study was performed in a nephrology department, so most patients presented with rapid progressive glomerulonephritis. “Therefore, the characteristics of the included patients may be biased to patients with severe kidney dysfunction.”
The authors explained that immunosuppressive therapy decreases serum immunoglobulin levels, which may lead to a decline in total protein level even if serum albumin levels are unchanged. They noted that serum immunoglobulin data at the time of the CMV antigenemia test were not obtained in their study. “The low hemoglobin and platelet count at the time of the CMV antigenemia test reflect the hematological effects of CMV viremia and/or infection.”
Reference
Harada M, Iwabuchi R, Yamaguchi A, et al. Predictive factors of cytomegalovirus viremia during the clinical course of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis: A single center observational study. J Clin Med. 2023;12(1):351. doi:10.3390/jcm12010351
