A Retrospective Analysis of Risk Factors of COVID-19 Associated Mucormycosis and Mortality Predictors: A Single-Center Study.

Kapil Zirpe,Anand M Tiwari,Prajakta Pote,Prasad Suryawanshi,Abhijit Deshmukh,Sushma K Gurav

doi:10.7759/cureus.18718

Abstract

BackgroundMucormycosis has been identified with increasing frequency in patients with coronavirus disease 2019 (COVID-19).AimsWe aimed to determine the in-hospital outcome of patients with COVID-19 associated mucormycosis (CAM).Materials and methodsThis was a single-center, retrospective, observational study. We included patients diagnosed with CAM from a tertiary care hospital in Pune, India. Clinical, laboratory, and in-hospital outcomes were noted. We analyzed factors associated with in-hospital mortality.ResultsBetween February 2021 and June 2021, we identified 84 patients of CAM. The mean age was 49.3 ± 12.1 years. Of the included patients, 64.3% had diabetes mellitus, and 83.3% had received steroids. Mucormycosis was diagnosed after a median of 11 days from the COVID-19 diagnosis. Orbital and central nervous system (CNS) involvement was seen in 29.8% and 23.8% of patients, respectively. During a mean hospital stay of 12.5 ± 8.5 days, 15.5% of patients died. Compared to survivors, the presence of chronic kidney disease (CKD) (p<0.0001), orbital involvement (p=0.039), use of tocilizumab (p<0.0001), and development of renal dysfunction during hospitalization (p<0.0001) were seen in a significantly higher proportion of nonsurvivors. The proportion of patients with diabetes, those receiving steroids, and mean glycosylated hemoglobin (HbA1c) levels did not differ significantly in survivors and nonsurvivors.ConclusionIn-hospital mortality in CAM is relatively lower in our institution. CKD, orbital involvement, use of tocilizumab, and renal dysfunction during hospital stay were found to be strong predictors of mortality.

Highlights

Over the last 19 months, the world has witnessed the devastating coronavirus disease 2019 (COVID-19) pandemic that has caused significant morbidity and mortality [1]
Mucormycosis was diagnosed after a median of 11 days from the COVID-19 diagnosis
Mucormycosis diagnosis was based on presenting clinical symptoms like eye pain, headache, facial swelling combined with appropriate imaging such as computerized tomography of the paranasal sinus (CT-PNS) or magnetic resonance imaging of paranasal sinus (MRI-PNS) and demonstration of fungi by methods such as screening by potassium hydroxide (KOH) mount, fungal culture, and histopathology

Summary

Introduction

Over the last 19 months, the world has witnessed the devastating coronavirus disease 2019 (COVID-19) pandemic that has caused significant morbidity and mortality [1]. In the second wave of the COVID-19 pandemic, India witnessed a significant increase in the incidence of COVID-19 associated mucormycosis (CAM) and contributed to over 70% of CAM cases worldwide [5]. CAM is observed in patients with ongoing COVID-19 or during convalescence. Mortality rates vary substantially in reported studies of CAM [7,9]. Studies assessing the predictors of mortality in CAM are lacking. We aimed to determine the predictors of in-hospital mortality in patients with CAM. Mucormycosis has been identified with increasing frequency in patients with coronavirus disease 2019 (COVID-19)

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Results

Discussion

Conclusion