Inflammatory indices as early predictors of mortality in mucormycosis

This study aimed to evaluate the predictive value of preoperative systemic inflammatory indices for in-hospital mortality in patients with sino-nasal-orbital mucormycosis.

A retrospective review was conducted on 26 patients diagnosed with microbiologically confirmed sino-nasal-orbital mucormycosis between February 2019 and June 2024 at a tertiary referral center. Demographic, clinical, laboratory, radiological, and outcome data were collected. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from routine blood counts. Patients were divided into survivor (n=14) and non-survivor (n=12) groups, and comparisons were made accordingly. ROC curve analysis was performed to assess the diagnostic performance of each marker.

The overall mortality rate was 46%. The lymphocyte count was significantly lower in the non-survivor group (p=0.027). Among the inflammatory indices, NLR, SII, and NMR were significantly higher in the non-survivor group (p=0.005, p=0.020, and p=0.023, respectively). NLR had the highest predictive value with an AUC of 0.82, sensitivity of 91.7%, and negative predictive value of 90%. COVID-19-associated mucormycosis cases demonstrated a significantly higher mortality rate (83.3%).

Preoperative inflammatory indices-particularly NLR-may serve as reliable, accessible biomarkers for mortality risk stratification in patients with mucormycosis. These markers can assist in early clinical decision-making, however, these findings should be interpreted with caution given the retrospective single-center design and small sample size.