Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Clin Microbiol Infect. 2021 Apr;27(4):538-549. doi: 10.1016/j.cmi.2020.12.035. Epub 2021 Jan 5.
Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM.
We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor.
We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors.
While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
肺毛霉菌病（PM）在免疫功能低下的患者中越来越多地被报道，死亡率很高。我们的目的是评估 PM 的死亡率及其随时间的变化趋势。我们还评估了联合内科-外科治疗在 PM 中的作用。
我们对 Pubmed、Embase 和 Cochrane 中央数据库进行了系统评价。如果研究描述了至少 5 例确诊的 PM 病例，并报告了死亡率，则符合纳入标准。我们还评估了联合内科-外科治疗与单纯内科治疗对 PM 死亡率的影响。我们使用随机效应模型估计 PM 的汇总死亡率，并在三个时间段进行比较。使用 meta 回归评估影响死亡率的因素。我们评估了以下因素的死亡风险差异（RD）：接受联合内科-外科治疗与单纯内科治疗的患者、孤立性 PM 与播散性疾病的患者、糖尿病（DM）与非 DM 作为危险因素的 PM 患者。
我们纳入了 79 项研究（1544 例患者）。PM 的汇总死亡率为 57.1%（95%置信区间[CI]51.7-62.6%）。死亡率随时间显著改善（2000 年前、2000-2009 年和 2010-2020 年的研究分别为 72.1%、58.3%和 49.8%，p<0.00001）。在调整研究设计、国家收入水平和样本量后，meta 回归证实了这种生存改善。联合内科-外科治疗与死亡 RD（95%CI）显著降低：-0.32（-0.49 至-0.16）。播散性疾病的死亡风险高于孤立性 PM，但 DM 与其他危险因素相比，死亡风险没有增加。
尽管 PM 仍然与高死亡率相关，但我们注意到随着时间的推移生存率有所提高。与单纯内科治疗相比，联合内科-外科治疗可提高生存率。
