Association between lymphocyte subsets and cytomegalovirus infection status among patients with systemic lupus erythematosus

Abstract

This study aimed to determine the association between different lymphocyte subsets and cytomegalovirus (CMV) infection status in patients with systemic lupus erythematosus (SLE). We performed a retrospective study among SLE patients with CMV infection and collected patient socio-demographic and clinical characteristics, as well as their recorded circulating lymphocyte subsets. Univariate and multivariable logistic regression analyses examined the relationship between CMV infection status and lymphocyte subset counts. We included 125 hospitalized patients with SLE, consisting of 88 with documented CMV infection and 37 without any evidence of CMV or other infections. Among the 88 CMV-infected patients, 65 (73.8%) patients developed CMV disease and 23 (26.2%) presented as CMV viremia. Compared to uninfected patients (1520 ± 101 cells/μL), lymphocytes remained stable among those with CMV viremia (1305 ± 272 cells/μL, P = .995). However, compared to their uninfected counterparts, there was a marked decrease in lymphocytes among patients with CMV disease (680 ± 513 cells/μL, P < .001). Analysis of lymphocyte subsets via flow cytometry showed that CD4+ T cell, CD8+ T cell, and natural killer cell counts were lower among those with CMV disease compared to those with CMV viremia and those without infection. Further, multivariable analysis showed that total lymphocyte (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998–1.000, P = .007) and CD4+ T cell counts (OR 0.99, 95% CI 0.992–0.998, P = .003) were negatively associated with CMV disease. Our findings support a potential inverse relationship between lymphopenia, specifically CD4+ T-cell lymphopenia, and CMV disease among hospitalized SLE patients.

The impact of charlson comorbidity index on mortality from SARS‐CoV‐2 virus infection and A novel COVID‐19 mortality index: CoLACD

“…In one of the first studies determining the characteristics of COVID‐19 infection Guan et al showed that Lymphopenia was observed in 82.1% of patients 11 . In several studies it has been found that the lymphocyte percentage descend with the disease, which indicates the direct result of viral infection 12‐14 . And last component of this novel scoring model is the absence of a respiratory symptom dyspnoea; in a meta‐analysis by Hu et al showed that the incidence of dyspnoea was 21.4% (95CI 15.3%‐27.5%) in COVID‐19 infected patients 15 .…”

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“…24,34,35 Cytomegalovirus D 1 1 2 X Xand upper respiratory tract viral infections are common in the SLE population, and may present with severe and atypical manifestations that mimic SLE flares. 28,36 Respiratory infections are one of the most common causes of hospitalization and early mortality in patients with SLE. 22 Elderly individuals (65 years of age) with rheumatic conditions are at greater risk of influenza and influenza-related complications.…”

“… 24 , 34 , 35 Cytomegalovirus (CMV) and upper respiratory tract viral infections are common in the SLE population, and may present with severe and atypical manifestations that mimic SLE flares. 28 , 36 …”

Human Cytomegalovirus and Autoimmune Diseases: Where Are We?

“…HCMV infection is also known to trigger SLE flares through direct cytopathic effects and/or activation of inflammatory processes, thus causing both systemic and organ-specific disease. Lastly, the clinical features of HCMV infection themselves happen to mimic SLE flares, further complicating the clinical picture of SLE patients [ 134 ].…”