Arora Shitij, Narayanan Shivakumar, Fazzari Melissa, Bhavana Kranti, Bharti Bhartendu, Walia Shweta, Kori Neetu, Kataria Sushila, Sharma Pooja, Atluri Kavya, Mandke Charuta, Gite Vinod, Redkar Neelam, Chansoria Mayank, Rawat Sumit Kumar, Bhat Rajani S, Dravid Ameet, Sethi Yatin, Barnawal Chandan, Sarkar Nirmal Kanti, Jariwala Sunit, Southern William, Puius Yoram
Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NW651, 111 E 210th Street, Bronx, NY 10467, USA.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
J Clin Med. 2022 Nov 27;11(23):7015. doi: 10.3390/jcm11237015.
COVID-19-associated mucormycosis (CAM) is associated with high morbidity and mortality. MUNCO is an international database used to collect clinical data on cases of CAM in real time. Preliminary data from the Mycotic Infections in COVID-19 (MUNCO) online registry yielded 728 cases from May to September 2021 in four South Asian countries and the United States. A majority of the cases (694; 97.6%) consisted of a mucormycosis infection. The dataset allowed for the analysis of the risk factors for adverse outcomes from CAM and this analysis is presented in this paper.
The submission of cases was aided by a direct solicitation and social media online. The primary endpoints were full recovery or death measured on day 42 of the diagnosis. All patients had histopathologically confirmed CAM. The groups were compared to determine the contribution of each patient characteristic to the outcome. Multivariable logistic regression models were used to model the probability of death after a CAM diagnosis.
The registry captured 694 cases of CAM. Within this, 341 could be analyzed as the study excluded patients with an unknown CAM recovery status due to either an interruption or a lack of follow up. The 341 viable cases consisted of 258 patients who survived after the completion of treatment and 83 patients who died during the period of observation. In a multivariable logistic regression model, the factors associated with an increased risk of mortality include old age (OR = 1.04, 95% CI 1.02-1.07, = 0.001), history of diabetes mellitus (OR 3.5, 95% CI 1.01-11.9, = 0.02) and a lower BMI (OR 0.9, 95% CI 0.82-0.98, = 0.03). Mucor localized to sinus disease was associated with 77% reduced odds of death (OR = 0.23, 95% CI 0.09-0.57, = 0.001), while cerebral mucor was associated with an increased odds of death (OR = 10.96, 95% CI 4.93-24.36, = ≤0.0001).
In patients with CAM, older age, a history of diabetes and a lower body mass index is associated with increased mortality. Disease limited to the sinuses without a cerebral extension is associated with a lower risk of mortality. Interestingly, the use of zinc and azithromycin were not associated with increased mortality in our study.
新型冠状病毒肺炎相关毛霉菌病（CAM）与高发病率和死亡率相关。MUNCO是一个用于实时收集CAM病例临床数据的国际数据库。新型冠状病毒肺炎（MUNCO）在线登记处的初步数据显示，2021年5月至9月在四个南亚国家和美国有728例病例。大多数病例（694例；97.6%）为毛霉菌感染。该数据集允许对CAM不良结局的危险因素进行分析，本文展示了这一分析结果。
通过直接征集和社交媒体在线辅助病例提交。主要终点是在诊断后第42天测量的完全康复或死亡。所有患者均经组织病理学确诊为CAM。对各组进行比较，以确定每个患者特征对结局的影响。多变量逻辑回归模型用于模拟CAM诊断后死亡的概率。
该登记处记录了694例CAM病例。其中，341例可进行分析，因为该研究排除了由于中断或缺乏随访而CAM恢复状态未知的患者。341例有效病例包括258例治疗完成后存活的患者和83例在观察期内死亡的患者。在多变量逻辑回归模型中，与死亡风险增加相关的因素包括老年（OR = 1.04，95%CI 1.02 - 1.07，P = 0.001）、糖尿病史（OR 3.5，95%CI 1.01 - 11.9，P = 0.02）和较低的体重指数（OR 0.9，95%CI 0.82 - 0.98，P = 0.03）。局限于鼻窦疾病的毛霉菌与死亡几率降低77%相关（OR = 0.23，95%CI 0.09 - 0.57，P = 0.001），而脑毛霉菌与死亡几率增加相关（OR = 10.96，95%CI 4.93 - 24.36，P =≤0.0001）。
在CAM患者中，老年、糖尿病史和较低的体重指数与死亡率增加相关。局限于鼻窦且无脑扩展的疾病与较低的死亡风险相关。有趣的是，在我们的研究中，锌和阿奇霉素的使用与死亡率增加无关。
