Exploring the Impact of Epstein-Barr Virus and Cytomegalovirus Reactivation on COVID-19 Severity and Host Immune Response

Abstract

Background: Reactivation of latent Epstein-Barr virus and cytomegalovirus is commonly observed among critically ill patients presenting with severe COVID-19. Methods: Retrospective cohort study comprising adult patients admitted to a simple hospital with COVID-19 infection from March 2020 to February 2022. Patients were divided into 2 groups: group 1 had viral reactivation with Epstein-Barr virus and/or Cytomegalovirus, and group 2 did not. Primary outcomes were the length of stay, mortality, need for mechanical ventilation, and the Ichikado computed tomography score. Descriptive statistics, Mann-Whitney U test, χ 2 test, and Fisher exact tests were used to ascertain statistical significance. Results: Nine hundred ninety-four patients were admitted due to COVID-19 pneumonia, 216 (21.73%) were found to have a viral reactivation with EBV and/or Cytomegalovirus. In this cohort, all the primary outcomes, with the exception of mechanical ventilation, were statistically significant. Patients in group 1 were found to have a longer length of stay (12 vs. 7 d, P <0.001), a higher Ichikado CT score (188 points vs. 160 points, P <0.001), and a higher mortality rate (39.8% vs. 13.9%, P <0.001). A higher APACHE score (11 points vs. 8 points, P <0.001) and Sequential Organ Failure Assessment score >2 on admission (48.6% and 32.6%, P <0.001) were more frequently reported in group 1. Conclusions: There was a higher risk of extended hospitalization, elevated mortality rates, and worse Ichikado CT scores in patients with COVID-19 pneumonia and Epstein-Barr virus and Cytomegalovirus reactivation.