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Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre
Valliappan Muthu1, Ritesh Agarwal1, Shivaprakash Mandya Rudramurthy2
1Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Objectives:
To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM.
Methods:
We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality.
Results:
We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival.
Discussion:
CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.
Insights
COVID-19-associated pulmonary mucormycosis (CAPM) is distinct from rhino-orbital mucormycosis (CAROM), with higher mortality. Hypoxemia during COVID-19 infection is linked to CAPM and increased mortality, alongside Aspergillus co-infection.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Mucormycosis is a severe fungal infection, with COVID-19 increasing its incidence.
- COVID-19-associated pulmonary mucormycosis (CAPM) and COVID-19-associated rhino-orbital mucormycosis (CAROM) are distinct clinical entities.
- Factors influencing the development and outcomes of CAPM require further investigation.
Purpose of the Study:
- To compare CAPM and CAROM in COVID-19 patients.
- To identify risk factors associated with CAPM.
- To determine factors linked to 12-week mortality in CAPM patients.
Main Methods:
- Retrospective, multicenter cohort study.
- Inclusion of COVID-19 patients with CAPM, CAROM, and controls without mucormycosis.
- Multivariable logistic regression analysis to assess associations with CAPM and mortality.
Main Results:
- CAPM patients had higher rates of male sex, renal transplantation, multimorbidity, intensive care admission, and glucocorticoid use compared to CAROM.
- COVID-19-related hypoxemia, male sex, rural residence, diabetes, elevated C-reactive protein, glucocorticoid, and zinc use were associated with CAPM.
- CAPM had significantly higher 12-week mortality (52.3%) than CAROM (30.5%).
- COVID-19 hypoxemia and Aspergillus co-infection independently predicted mortality in CAPM.
Conclusions:
- CAPM is a distinct clinical entity with a worse prognosis than CAROM.
- COVID-19-related hypoxemia is a significant risk factor for developing CAPM.
- COVID-19 hypoxemia and Aspergillus co-infection are independent predictors of mortality in CAPM patients.
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