COVID-19 相关的 rhino-orbito-cerebral mucormycosis，危险因素和预后预测因素；一项多中心研究。

COVID-19 associated rhino-orbito-cerebral mucormycosis, risk factors and outcome predictors; a multicentric study.

机构信息

Farabi Comprehensive Center of Excellence in Ophthalmology, Department of Oculofacial Plastic and Orbital Surgery, Tehran University of Medical Sciences, Tehran, Iran.

Eye Research Center, Department of Eye, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.

出版信息

Int Ophthalmol. 2023 Apr;43(4):1375-1386. doi: 10.1007/s10792-022-02536-7. Epub 2022 Oct 9.

DOI:10.1007/s10792-022-02536-7

PMID:36209307

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9547750/

Abstract

BACKGROUND

Since the onset of the Covid-19 pandemic, an increase in mucormycosis cases has been observed in many countries, including Iran. However, the role of covid-19 and associated risk factors have not been thoroughly investigated.

OBJECTIVE

This study is designed to identify epidemiologic characteristics, risk factors, and outcome predictors of Covid-19-Associated Rhino-Orbito-Cerebral Mucormycosis (C-ROCM).

METHODS

Data of pathology proven Covid Associated ROCM cases were retrospectively obtained from 7 tertiary care centers throughout Iran from February 20, 2021, to July 22, 2021. Univariate and multivariate analyses were performed using binary logistic regression to assess the effects of various factors on the outcome.

RESULTS

A total of 132 patients with C-ROCM were included in the study. The mean age of patients was 61.6 ± 13.9 (60.6% male). In 12 patients (9.1%), both eyes were involved. Diabetes was the most common comorbidity (94.7%). The mortality rate was 9.1%, higher in males (12.5%) than females (3.8%). Severe vision impairment was seen in 58 patients (43.9%). Main factors that had a negative impact on the outcome in the univariate analysis include older age (P < 0.001), higher steroid dosage (P < 0.001), higher HbA1c level (P < 0.001), Covid-19 severity (P < 0.001), and brain involvement (P < 0.001). However, in the multivariate analysis, the effects of age (P = 0.062), steroid dosage (P = 0.226), and Covid-19 intensity (P = 0.084) decreased, and the difference was no longer statistically significant. CRAO was a predictor of mortality in the univariate analysis (P = 0.008, OR = 4.50), but in the multivariate analysis, this effect decreased and was no longer significant (P = 0.125).

CONCLUSION

The risk of C-ROCM and its complications may increase in patients with more severe Covid-19, steroid over-prescription, ICU admission due to Covid-19, and poor glycemic control during and after Covid-19 treatment.

摘要

背景

自新冠疫情大流行以来，许多国家（包括伊朗）都观察到了毛霉菌病病例的增加。然而，新冠病毒的作用和相关的危险因素尚未得到彻底研究。

目的

本研究旨在确定新冠相关鼻-眶-脑毛霉菌病（C-ROCM）的流行病学特征、危险因素和结局预测因素。

方法

本研究回顾性收集了 2021 年 2 月 20 日至 2021 年 7 月 22 日期间伊朗 7 家三级护理中心的病理证实的新冠相关 ROCM 病例数据。使用二元逻辑回归分析进行单变量和多变量分析，以评估各种因素对结局的影响。

结果

本研究共纳入 132 例 C-ROCM 患者。患者的平均年龄为 61.6±13.9 岁（60.6%为男性）。在 12 例患者（9.1%）中，双眼受累。糖尿病是最常见的合并症（94.7%）。死亡率为 9.1%，男性（12.5%）高于女性（3.8%）。58 例患者（43.9%）存在严重视力障碍。单变量分析中对结局有负面影响的主要因素包括年龄较大（P<0.001）、较高的类固醇剂量（P<0.001）、较高的糖化血红蛋白水平（P<0.001）、新冠严重程度（P<0.001）和脑受累（P<0.001）。然而，在多变量分析中，年龄（P=0.062）、类固醇剂量（P=0.226）和新冠严重程度（P=0.084）的影响降低，且差异不再具有统计学意义。CRAO 在单变量分析中是死亡率的预测因素（P=0.008，OR=4.50），但在多变量分析中，这种影响降低且不再具有统计学意义（P=0.125）。