• François Guiouillier, Jean Derely, Alexandre Salvadori, Jonas Pochard, Jérôme Le Goff, Thibault Martinez, Florent Raffin, Philippe Laitselart, Charlotte Beaucreux, Sonia Priou, Pierre-Louis Conan, Vincent Foissaud, Aurélie Servonnet, Philippe Vest, Mathieu Boutonnet, Stéphane de Rudnicki, Christine Bigaillon, and Nicolas Libert.
• Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France.
• Intensive Care Med. 2024 Mar 1; 50 (3): 418426418-426.

PurposeHerpesvirus reactivation has been documented among patients in the intensive care unit (ICU) and is associated with increased morbidity and mortality, particularly for cytomegalovirus (CMV). Epstein-Barr virus (EBV) has been poorly studied despite >95% of the population being seropositive. Our preliminary study suggested an association between EBV reactivation and increased morbidity and mortality. This study aimed to investigate this association among patients admitted to the ICU.MethodsIn this multicenter prospective study, polymerase chain reaction was performed to quantify EBV in patients upon ICU admission and then twice a week during their stay. Follow-up was 90 days.ResultsThe study included 129 patients; 70 (54.3%) had EBV reactivation. On day 90, there was no difference in mortality rates between patients with and without reactivation (25.7% vs 15.3%, p = 0.22). Patients with EBV reactivation at admission had increased mortality compared with those without reactivation and those with later reactivation. EBV reactivation was associated with increased morbidity. Patients with EBV reactivation had fewer ventilator-free days at day 28 than those without reactivation (18 [1-22] vs. 21 days [5-26], p = 0.037) and a higher incidence of acute respiratory distress syndrome (34.3% vs. 17%, p = 0.04), infections (92.9% vs. 78%, p = 0.03), and septic shock (58.6% vs. 32.2%, p = 0.004). More patients with EBV reactivation required renal replacement therapy (30% vs. 11.9%, p = 0.02). EBV reactivation was also associated with a more inflammatory immune profile.ConclusionWhile EBV reactivation was not associated with increased 90-day mortality, it was associated with significantly increased morbidity.© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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