Clinical Profile and Factors Associated with Adverse Outcomes in Coronavirus Disease 2019-associated Mucormycosis: A Single-centre Study
Authors: Nair Krishna S ,   Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Alagesan Murali ,   Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Jose Dhanya ,   Department of Community Medicine, Goa Medical College, Goa, India, Yoganathan Chidambaram ,   Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Saravanan Rethinam ,   Department of Oral & Maxilofacial Surgery, PSGSSH, Coimbatore, India, Karthikeyan Krishnasamy ,   Department of ENT, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Divya Karuppannasamy ,   Department of Opthalmology, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Babu Dinesh ,   Department of Dental Surgery, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Rajan Cyril ,   Department of General Medicine, PSG Institute of Medical Sciences and Research Center, Coimbatore, India, Pappachan Joseph M ,   Department of Medicine & Endocrinology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK,   Faculty of Science, Manchester Metropolitan University, Manchester, UK
Published: June 2023

Background: The coronavirus disease 2019 (COVID-19) pandemic was associated with an increased incidence of mucormycosis globally. However, the clinical pattern, epidemiologic features and risk factors for adverse outcomes are not well established. Methods: We performed a retrospective analysis of the data from patients hospitalized with proven mucormycosis between April 2021 and August 2021. Patients were managed with a multi-disciplinary approach involving medical, surgical, and comorbidity treatment. The clinical presentation, management details, complications and outcomes, including mortality, were reviewed from clinical records. Results: The mean age of presentation was 53.7 (± 11.8) years, and 88 (84.6%) were men. Of the 104 cases with COVID-19-associated mucormycosis, 97 (93.27%) patients had diabetes, and 80.8% had a haemoglobin A1C (HbA1c) of ≥6.4% at diagnosis. Seventy percent of diabetes cases experienced steroid-induced hyperglycaemia during treatment. Even with appropriate treatment, 17 (16.35%) patients died. High HbA1c and creatinine levels, presence of chronic kidney disease (CKD), need for intensive care unit admission, and orbital evisceration were the risk factors associated with high mortality on multivariate logistic regression analysis. Cox regression analysis revealed that the overall mortality increased by a factor of 12% with each 1 percentage point increase in HbA1c ≥6.4% (hazard ratio 1.12; 95% confidence interval 0.95–1.31). The mortality risk was even higher when diabetes was associated with CKD (hazard ratio 1.82; 95% confidence interval 0.24–14.00). Conclusion: High HbA1c and creatinine levels, intensive care unit admission, CKD, and aggressive disease requiring orbital evisceration are the predictors of mortality in patients with COVID-19-associated mucormycosis. Patients with these risk factors should be managed more actively to reduce morbidity and mortality.