Distribution characteristics and influencing factors of active cytomegalovirus infection in patients with hematological malignancies complicated with sepsis

BACKGROUND: Cytomegalovirus (CMV) tends to reactivate in immunocompromised individuals. Patients with hematological malignancies are at high risk of CMV infection due to treatment-related immunosuppression, and sepsis may further promote latent CMV reactivation via inflammatory disorders. However, research on active CMV infection in patients with both conditions remains limited. METHODS: A single-center retrospective cohort study included 119 patients with hematological malignancies complicated by sepsis (Ningbo Medical Center Lihuili Hospital, June 2022-June 2025). Patients were divided into active CMV infection group (plasma CMV DNAemia ≥ 500 copies/mL, 41 cases) and non-active group (< 500 copies/mL, 78 cases) via qPCR. Clinical features, laboratory indicators, treatment, and outcomes were compared; regression analysis screened risk factors, and ROC curves assessed predictive value of indicators. RESULTS: Active CMV infection incidence was 34.45%, with 92.68% occurring within 0-7 days of hospitalization. CMV was detected in lower respiratory tract specimens of 21.84% patients, and plasma CMV load correlated positively with that in these specimens (r = 0.558, P < 0.001). The active group had lower weight, BMI, hemoglobin, albumin, white blood cell and platelet counts, but higher SOFA scores and body temperature (all P < 0.05). The active group had higher rates of blood transfusion and immunosuppressant use, longer hospitalization and fever duration, and higher 28-day all-cause mortality (all P < 0.05); no difference in complication incidence was observed. Decreased white blood cell count was an independent risk factor (β=-0.209, OR = 0.811, P = 0.021) with optimal predictive value (AUC = 0.746); hemoglobin and platelet count also had good predictive value. CONCLUSIONS: Patients with hematological malignancies complicated by sepsis have high active CMV infection incidence (mostly early hospitalization), associated with poor prognosis. Decreased white blood cell count is a useful early screening indicator, requiring early clinical monitoring and intervention.