Viral reactivation in the lungs of patients with severe pneumonia is associated with increased mortality, a multicenter, retrospective study

Abstract Purpose: This study aims to assess the clinical features of virome in the early onset of severe pneumonia in ICU patients.Methods: A total of 97 patients’ clinical data was collected retrospectively from intensive care units of five teaching hospitals in China from June 2018 to July 2021 followed by metagenomic next-generation sequencing (mNGS) of the bronchoalveolar lavage fluid (BALF) at the onset of severe pneumonia.Results: Cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), and Epstein-Barr virus (EBV) were the most common reactivated viruses in the lower respiratory tract of patients with severe pneumonia. After adjusting for the risk of confounding and competition, viral reactivation resulted in an overall increase of 2.052 folds of 28-day all-cause mortality (95% CI: 1.004-4.194). Conclusion: This study showed that CMV, HSV-1, and EBV were the most common reactivated viruses in the lungs of patients in the ICU at the onset of severe pneumonia. Viral reactivation is common and associated with an increased risk of mortality.