Z Gastroenterol 2025; 63(08): e565-e566
DOI: 10.1055/s-0045-1811002
Abstracts | DGVS/DGAV
Kurzvorträge
Gut Feeling: Mikrobiom und Barriere im Fokus Freitag, 19. September 2025, 08:30 – 09:50, Vortragsraum 10

Higher prevalence of Cytomegalovirus and Epstein–Barr virus in acute-on-chronic liver failure

Authors

  • J Sonnenberg

    1   Universitätsklinikum Münster, Münster, Deutschland

  • K Thiyagarajah

    2   Paul-Ehrlich-Institut, Langen, Deutschland
    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • E Görgülü

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • P Lembeck

    1   Universitätsklinikum Münster, Münster, Deutschland

  • N Kraus

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • M Glitscher

    2   Paul-Ehrlich-Institut, Langen, Deutschland

  • F E Uschner

    1   Universitätsklinikum Münster, Münster, Deutschland

  • M J Brol

    1   Universitätsklinikum Münster, Münster, Deutschland

  • W Gu

    1   Universitätsklinikum Münster, Münster, Deutschland

  • R Schierwagen

    1   Universitätsklinikum Münster, Münster, Deutschland

  • S Klein

    1   Universitätsklinikum Münster, Münster, Deutschland

  • M S Schulz

    1   Universitätsklinikum Münster, Münster, Deutschland

  • M M Mücke

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • T Wiedemann

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • P A Reuken

    4   Universitätsklinikum Jena, Jena, Deutschland

  • J Reißing

    5   Universitätsklinikum Aachen, Aachen, Deutschland

  • F Schneider

    6   Universitätsklinikum Bonn, Bonn, Deutschland

  • M Praktiknjo

    1   Universitätsklinikum Münster, Münster, Deutschland

  • P-R Tepasse

    1   Universitätsklinikum Münster, Münster, Deutschland

  • J Fischer

    1   Universitätsklinikum Münster, Münster, Deutschland

  • S Zeuzem

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • C Welsch

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • S Ciesek

    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland

  • A Stallmach

    4   Universitätsklinikum Jena, Jena, Deutschland

  • J Trebicka

    1   Universitätsklinikum Münster, Münster, Deutschland

  • J Chang

    6   Universitätsklinikum Bonn, Bonn, Deutschland

  • T Bruns

    5   Universitätsklinikum Aachen, Aachen, Deutschland

  • E Hildt

    2   Paul-Ehrlich-Institut, Langen, Deutschland
    7   Hasso-Plattner-Institute-Digital Health Cluster, Potsdam, Deutschland

  • K-H Peiffer

    1   Universitätsklinikum Münster, Münster, Deutschland
    3   Universitätsklinikum Frankfurt, Frankfurt, Deutschland
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    Background & Aims: Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome characterized by acute decompensation and multi-organ failure in patients with pre-existing chronic liver disease. Patients who develop ACLF within 90 days are referred to as pre-ACLF. Known precipitants include bacterial infections and viral hepatitis. However, in 40-60% of patients the precipitant remains unknown. Cytomegalovirus (CMV) and Epstein Barr virus (EBV) are highly prevalent viruses, but their impact on ACLF is unclear.

    Methods: A total of 211 patients (43 ACLF, 16 pre-ACLF, 152 non-ACLF) of the ACLF-I cohort study and an external validation cohort (Aachen, Jena and Bonn) with 153 patients (39 ACLF, 33 pre-ACLF, 81 non-ACLF) were included. All were analysed for CMV/EBV DNAemia (multiplex-qPCR), cytokine assays were performed in 102 ACLF-I samples (multiplex assays) and correlated with clinical data.

    Results: Higher prevalence of CMV DNAemia (25.6% vs. 8.9%, OR 3.88, 95% CI 1.61-9.36, p<0.01) and EBV DNAemia (16.3% vs. 6.0%, OR 3.71, 95% CI 1.30-10.59, p<0.05) was observed in the ACLF-I, despite absence of clinical signs of viral infections. 54.8% of DNAemic ACLF patients in the validation cohort had no identified precipitant compared to 26.5% in ACLF patients without DNAemia (p<0.05). CMV was associated with liver failure (p<0.001) and in the regression model 90-day mortality (p<0.001). DNAemia was associated with a distinct pattern of inflammatory activity. The results were validated externally, with pre-ACLF additionally showing trends towards a higher frequency of DNAemia (pre-ACLF vs. non-ACLF CMV 15.2% vs. 4.9%, p=0.065, EBV 9.1% vs. 2.4%, p=0.103).

    Conclusion: CMV and EBV DNAemia are more frequently observed in ACLF. Presence of CMV/EBV DNAemia in chronic liver disease may contribute to the development of ACLF by exacerbating liver inflammation and impairing hepatocellular function. Our data suggest that CMV/EBV DNAemia may represent a precipitant and/or consequence of ACLF.


     

    Publication History

    Article published online:
    04 September 2025

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