Characteristics of Mucormycosis in Hematological Patients and a Death Prediction Model.

Xiaoxu Ma,Jiajun Chen,Pengfei Jiao,Huiling Li,Qingxian Zhang,Haizhou Xing,Li Li,Suping Zhang,Lihua Xing,Weijie Cao,Aiguo Xu,Ang Li,Wenliang Tian

doi:10.3389/fmicb.2021.784974

Abstract

Mucormycosis is an angioinvasive fungal infection, associated with high mortality. The aim of our study was to explore the high-risk factors and predict the death of hematological disease complicated with mucormycosis. We retrospectively analyzed clinical data of 31 patients with hematological disease complicated with mucormycosis, adopted random forest to establish the death prediction model, and validated the model in another 15 patients. The median age of the 31 cases was 46 (28–51) years, male to female ratio 1.38:1, and 90-day mortality rate 54.8%. The most common underlying disease was acute myeloid leukemia (58.1%). The main clinical symptoms were fever (100%), cough (87.1%), sputum (80.6%), chest pain (61.3%), and hemoptysis (19.4%). Reversed halo sign (83.9%) was the most common computed tomography sign. A total of 48.4% of patients also had aspergillus or bacterial infections. Discriminative models were constructed by random forest with 17 non-survivors and 14 survivors. Procalcitonin, the duration of intravenous administration of amphotericin B or amphotericin B liposomes, and neutropenia at death or 90 days of survival were the leading risk factors for poor prognosis, with area under the curve of 0.975 (95% CI 0.934–1). We chose 0.6775 as death prediction threshold (with 82.3% sensitivity and 100% specificity) and validated the model successfully in another 15 patients. Chest pain and reversed halo sign are specific clinical and image signs of hematological disease complicated with mucormycosis. Neutropenia, elevated procalcitonin, and insufficient use time of amphotericin B or amphotericin B liposomes are risk factors for death.

Highlights

Mucormycosis is a rare but life-threatening fungal infection
The mortality of hematological disease complicated with mucormycosis (HDM) is much higher than other underlying diseases up to 88% (Kennedy et al, 2016; Jestin et al, 2021), which has become an important factor leading to the death of patients with hematological diseases
There was no significant difference in symptoms between the improved group (IG) and the death group (DG)

Summary

Introduction

Mucormycosis is a rare but life-threatening fungal infection It often occurs in patients with diabetes mellitus, hematological malignancy, solid organ transplantation, bone marrow transplantation, and trauma (Roden et al, 2005; Feng and Sun, 2018). Studies have shown that early diagnosis and timely initiation of medical therapy are the key factors in reducing the mortality of mucormycosis (Chamilos et al, 2008; Jeong et al, 2015). Establishing a predictive model can calculate the probability of over-all mortality due to mucormycosis, identify high-risk patients as early as possible, and give support to reduce mortality as soon as possible

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Conclusion