Department of Otorhinolaryngology, University of Mersin School of Medicine, Çiftlikköy Kampüsü, Çiftlikköy/Yenişehir, Mersin, Turkey.
Department of Pathology, University of Mersin School of Medicine, Mersin, Turkey.
Eur Arch Otorhinolaryngol. 2022 Mar;279(3):1363-1369. doi: 10.1007/s00405-021-06910-6. Epub 2021 Jun 1.
To investigate the factors affecting disease specific mortality (DSM) in patients with mucormycosis.
This retrospective study included 24 patients diagnosed with mucormycosis and who had undergone surgical and medical treatment between 2010 and 2020. There were 14 male and 10 female patients whose mean age was 53.70 ± 16.87 years, range 18-83. We reviewed the factors affecting DSM, including the extent of disease (paranasal sinus, palatal, orbital or intracranial involvement) and blood parameters (BP) that are serum glucose level (SGL), white blood cell, neutrophil, lymphocyte counts, C-reactive protein and hemoglobulin levels. Also, the effect of SGL in diabetes mellitus and BP in hematological malignancies on DSM was additionally evaluated.
Orbital (p = 0.001) and intracranial (p < 0.01) involvement had statistically significant effect on DSM but not the palatal involvement. When Cox regression analysis was employed to analyze the effect of multiple independent factors on DSM, only the extent of disease (p = 0.023) had statistically significant effect. Receiver operating characteristic analysis of SGL for diabetic patients demonstrated that the area under the curve was 0.917 (p = 0.016). A cut-off SGL of 360 mg/dl revealed an 83.3% sensitivity and 83.3% specificity for mortality outcome for diabetic patients having mucormycosis.
Orbital or cerebral involvement is related to a poor prognosis, so early endoscopic nasal examination, diagnosis and treatment are of vital importance for DSM in mucormycosis. Serum glucose level over 360 mg/dl in uncontrolled diabetic patients with fever, ophthalmological findings and facial hypoesthesia should necessitate a consultation to an otolaryngologist and an endoscopic careful nasal examination.
探讨影响毛霉菌病患者疾病特异性死亡率（DSM）的因素。
本回顾性研究纳入了 2010 年至 2020 年间接受手术和药物治疗的 24 例毛霉菌病患者。其中男 14 例，女 10 例，平均年龄 53.70±16.87 岁，年龄 18-83 岁。我们回顾了影响 DSM 的因素，包括疾病程度（鼻窦、腭、眼眶或颅内受累）和血液参数（BP），包括血清葡萄糖水平（SGL）、白细胞、中性粒细胞、淋巴细胞计数、C 反应蛋白和血红蛋白水平。此外，还评估了糖尿病患者 SGL 和血液系统恶性肿瘤患者 BP 对 DSM 的影响。
眼眶（p=0.001）和颅内（p<0.01）受累对 DSM 有统计学显著影响，但腭受累无统计学显著影响。当采用 Cox 回归分析来分析多个独立因素对 DSM 的影响时，只有疾病程度（p=0.023）有统计学显著影响。SGL 对糖尿病患者的 DSM 进行受试者工作特征曲线分析显示，曲线下面积为 0.917（p=0.016）。SGL 截断值为 360mg/dl 时，糖尿病合并毛霉菌病患者死亡率的敏感性为 83.3%，特异性为 83.3%。
眼眶或脑部受累与预后不良有关，因此早期进行鼻内镜检查、诊断和治疗对毛霉菌病的 DSM 至关重要。对于有发热、眼部表现和面部感觉减退的未控制糖尿病患者，如果 SGL 超过 360mg/dl，应咨询耳鼻喉科医生并进行仔细的鼻内镜检查。
