Reactivation of Epstein-Barr Virus Among Neurointensive Care Patients: A Prospective Observational Study.

Aims/Background Approximately 90% of the population is seropositive for Epstein-Barr virus (EBV), and its reactivation has been reported to be associated with increased morbidity and mortality in critically ill patients. However, the clinical significance of EBV reactivation among patients in neurointensive care units (NICU) has rarely been investigated. This study aimed to demonstrate the association between EBV reactivation and clinical outcomes in neurocritically ill patients. Methods Clinical data were collected from 179 patients admitted to the NICU of the Chinese PLA General Hospital between October 2021 and January 2024. These patients were divided into two groups based on EBV infection status: the EBV reactivation group (n = 80) and the non-EBV reactivation group (n = 99). Gender, age, laboratory test results, diagnosis and functional prognosis were compared between the two groups to evaluate the clinical significance of EBV reactivation in neurocritically ill patients. Results A total of 179 patients were included in this study, of which 80 (44.69%) had EBV reactivation. Patients with EBV reactivation demonstrated higher levels of serum lactic dehydrogenase (32.50% versus 16.16%, p = 0.010), C-reactive protein (36.25% versus 21.21%, p = 0.026), immunoglobulin G (26.25% versus 12.12%, p = 0.015), cerebrospinal fluid leukocyte counts (67.50% versus 47.47%, p = 0.007), interleukin-6 (68.75% versus 42.42%, p < 0.001), and interleukin-10 (33.75% versus 17.17%, p = 0.010). There was no significant difference in 6-month mortality between patients with and without EBV reactivation (7.50% versus 3.03%, p = 0.302). However, patients with EBV reactivation exhibited poorer functional prognosis compared to those without (42.50% versus 26.26%, p = 0.022). Central nervous system lymphoproliferative disorders are more common in patients with EBV reactivation. Conclusion EBV reactivation is frequent among immunocompetent, neurocritically ill patients and is associated with poorer functional prognosis but not with increased 6-month mortality. Furthermore, EBV reactivation is associated with systemic inflammation.