THU330 No Calm After The Storm : Is Blood Glucose Level At Patient Presentation Related To The Stage And Outcome Of Mucormycosis In COVID- 19 Pandemic?
Authors: Sharma Vagisha , Kriplani Kushal , Tuli Ishapreet , Sharma Shilpam 
Published: October 2023

Abstract
Disclosure: V. Sharma: None. K. Kriplani: None. I. Tuli: None. S. Sharma: None.
Mucormycosis is one of the most aggressive opportunistic fungalinfections. Although conventionally limited to the demographics of severelyimmunocompromised and those with uncontrolled hyperglycemia and/orketoacidosis, in recent times, has propelled to the frontline in investigationsof COVID-19 complications. It can present in 4 stages, with progressiveinvolvement of the nasal mucosa, the paranasal sinuses, the orbit and thebrain. The stage of Mucormycosis at presentation critically influences academicdialogue on its clinical outcome and treatment options. However, prior researchhas failed to evaluate an association of patient factors especially HbA1clevels and Random Blood sugar(RBS) at presentation with the Stage and patientoutcome of Mucormycosis. A total of 75 patients with laboratory confirmedMucormycosis were enrolled in the study. Mean age of the participants was 45.17years of which 85.33% were survivors . Although there was no statisticallysignificant difference between the survivors and non-survivors concerning meanHbA1C and RBS levels, there was a statistically significant association betweenthe Stage of Mucormycosis and the level of HbA1c and RBS at presentation forStages 2b, 2c, 2d,3a, 3b, 3c, 4a, 4b, and 4c. This leads to the understandingthat clinicians must order blood sugar and HbA1c level at presentation as cuesto a better understanding of disease severity. The most common comorbidcondition was diabetes mellitus, however, only coronary artery disease in thepatient was found to be significantly correlated with mortality, while othersincluding diabetes mellitus, hypertension, chronic steroids use,immunocompromised status, and history of COVID-19 had no significantassociation. The patients with a history a COVID reported a statisticallysignificant higher RBS level than those without. Development or worsening ofdiabetes mellitus is on the long list of COVID-19 complications. Prior studiesreported an increased incidence of Mucormycosis cases in COVID-19 patients -both with diabetes (80%) and/or DKA(14.9%)(1). The binding of SARS-CoV-2 toACE2 receptors resulting in beta cell apoptosis and an ensuing cascade ofvirion, redox and cytokine storms are the simplified mechanisms of type 1 and 2diabetes development respectively, in COVID patients(2). Previous literaturesuggests a statistically significant association between stage of Mucormycosisat presentation and serum lipid profile(3), and serum iron and inflammatorymarkers levels(4). According to the data available from various sources, nosuch study compared the levels of RBS and HbA1C with the stageof Mucormycosis. Reference: (1)Hill et al, Metabolism: clinical andexperimental. 2020 Jun;107:154217 (2) Handayani et al, Obes Med. 2021May;23:100333. (3) Vijay et al, J Assoc Physicians India. 2022 Apr;70(4):11-12(4) Rao et al, J Assoc Physicians India. 2022 Apr;70(4):11-12.
Presentation: Thursday, June 15, 2023