One-Year Patient Survival After COVID-19-Associated Rhino-Orbital-Cerebral Mucormycosis: A Multicenter Study

Since December 2019, a serious health crisis caused by severe acute respiratory syndrome-Coronavirus-2 affected all aspects of human lives. The available data about COVID-19-associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) survival issues are based on studies on small populations with limited follow-up durations. Therefore, this multicenter cohort of a large population with CA-ROCM is aiming to report the one-year survival rate and investigate the potential responsible risk factors affecting the mortality.

This prospective, longitudinal, multicenter study included CA-ROCM patients from eight tertiary ophthalmology centers across Iran. Demographic, clinical, and therapeutic data were collected and patients were followed for a year. Survival analysis was performed using Cox proportional hazards models to identify mortality-associated risk factors. The research protocol is also available on ClinicalTrials.gov (NCT05097664).

Among the 246 patients, 183 (74.4%) survived within a year and 63 (25.6%) died. Significant mortality risk factors included need for orbital exenteration (HR = 3.01 vs. other treatments, p = 0.019), advanced disease stage (HR = 2.43 stage IV vs. II, p = 0.02), age (HR = 1.05, p < 0.001), and diabetes duration (HR = 1.05, p = 0.002). Paradoxically, steroid administration for COVID management was associated with improved survival (HR = 2.72 for no steroids, p = 0.018).

COVID-19-associated Rhino-Orbital-Cerebral Mucormycosis carries a substantial one-year survival rate of 74.4% in Iran. Age, diabetes, advanced disease stage, and need for orbital exenteration are the probable fatal risk factors. Interestingly, administration of steroids for COVID management was associated with a better survival.