Department of Ophthalmology, St. John's Medical College, Bangalore, Karnataka, India.
Department of Internal Medicine, St. John's Medical College, Bangalore, Karnataka, India.
Indian J Ophthalmol. 2022 Aug;70(8):3096-3101. doi: 10.4103/ijo.IJO_448_22.
Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19-associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM.
This case-control study included all COVID-19-associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients.
The study included 69 patients with COVID-19-associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19-associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03-1.78), blood glucose (OR = 1.008, 95% CI: 1.003-1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02-1.17) were associated with increased odds of developing COVID-19-associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30-9.02) and blood glucose (OR = 1.02, 95% CI: 1.005-1.03) (P = 0.02) had a higher probability of developing COVID-19-associated ROCM than patients with established DM.
Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19-induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19-associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
在持续的 2019 年冠状病毒病（COVID-19）大流行期间，印度经历了 COVID-19 相关的鼻-眶-脑毛霉菌病（ROCM）流行。本研究旨在描述流行病学特征，并阐明 COVID-19 相关 ROCM 的发病风险因素，同时比较 COVID-19 患者中有无 ROCM 的风险因素。
本病例对照研究纳入了 2021 年 5 月 1 日至 7 月 30 日期间在我院治疗的所有 COVID-19 相关 ROCM 患者。对照组包括同期年龄和性别匹配的无 ROCM 的 COVID-19 患者（精确匹配，1:2 比例）。采用条件逻辑回归进行匹配对分析，以研究各种风险因素与 COVID-19 患者 ROCM 发展之间的关系。
研究纳入了 69 例 COVID-19 相关 ROCM 患者和 138 例年龄和性别匹配的对照组。在流行病学方面，COVID-19 相关 ROCM 主要影响男性（59/69，85%），年龄在 50 岁出头（平均 52 岁），其中 48%（33/69）的患者来自资源有限的医疗环境。多变量条件逻辑回归分析显示，血清糖化血红蛋白（HbA1c）升高（比值比[OR] = 1.36，95%置信区间[CI]：1.03-1.78）、血糖（OR = 1.008，95%CI：1.003-1.013）和 C 反应蛋白（CRP）（OR = 1.07，95%CI：1.02-1.17）与 COVID-19 相关 ROCM 发病风险增加相关。HbA1c 和血糖水平升高（OR = 3.42，95%CI：1.30-9.02）和血糖水平升高（OR = 1.02，95%CI：1.005-1.03）（P = 0.02）且未确诊糖尿病的患者比已确诊糖尿病患者更有可能发生 COVID-19 相关 ROCM。
COVID-19 引起的促炎状态（CRP 升高）导致的未控制的糖尿病（HbA1c 和血糖升高表明）是 COVID-19 相关 ROCM 的主要独立危险因素。来自资源受限环境、未确诊糖尿病的中年男性风险尤其高。
