tetano
Editor, Senior Moderator
J Clin Med
. 2022 Nov 27;11(23):7015.
doi: 10.3390/jcm11237015.
Factors Associated with Mortality in Coronavirus-Associated Mucormycosis: Results from Mycotic Infections in COVID-19 (MUNCO) Online Registry
Shitij Arora[SUP] 1 [/SUP], Shivakumar Narayanan[SUP] 2 [/SUP], Melissa Fazzari[SUP] 3 [/SUP], Kranti Bhavana[SUP] 4 [/SUP], Bhartendu Bharti[SUP] 4 [/SUP], Shweta Walia[SUP] 5 [/SUP], Neetu Kori[SUP] 5 [/SUP], Sushila Kataria[SUP] 6 [/SUP], Pooja Sharma[SUP] 6 [/SUP], Kavya Atluri[SUP] 7 [/SUP], Charuta Mandke[SUP] 8 [/SUP], Vinod Gite[SUP] 9 [/SUP], Neelam Redkar[SUP] 10 [/SUP], Mayank Chansoria[SUP] 11 [/SUP], Sumit Kumar Rawat[SUP] 12 [/SUP], Rajani S Bhat[SUP] 13 [/SUP], Ameet Dravid[SUP] 14 [/SUP], Yatin Sethi[SUP] 15 [/SUP], Chandan Barnawal[SUP] 16 [/SUP], Nirmal Kanti Sarkar[SUP] 17 [/SUP], Sunit Jariwala[SUP] 18 [/SUP], William Southern[SUP] 1 [/SUP], Yoram Puius[SUP] 19 [/SUP], MUNCO Registry
Affiliations
Abstract
Background: 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.
Methods: 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.
Results: 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, p = 0.001), history of diabetes mellitus (OR 3.5, 95% CI 1.01-11.9, p = 0.02) and a lower BMI (OR 0.9, 95% CI 0.82-0.98, p = 0.03). Mucor localized to sinus disease was associated with 77% reduced odds of death (OR = 0.23, 95% CI 0.09-0.57, p = 0.001), while cerebral mucor was associated with an increased odds of death (OR = 10.96, 95% CI 4.93-24.36, p = ≤0.0001).
Conclusion: 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.
Keywords: coronavirus; mucormycosis; steroids.
. 2022 Nov 27;11(23):7015.
doi: 10.3390/jcm11237015.
Factors Associated with Mortality in Coronavirus-Associated Mucormycosis: Results from Mycotic Infections in COVID-19 (MUNCO) Online Registry
Shitij Arora[SUP] 1 [/SUP], Shivakumar Narayanan[SUP] 2 [/SUP], Melissa Fazzari[SUP] 3 [/SUP], Kranti Bhavana[SUP] 4 [/SUP], Bhartendu Bharti[SUP] 4 [/SUP], Shweta Walia[SUP] 5 [/SUP], Neetu Kori[SUP] 5 [/SUP], Sushila Kataria[SUP] 6 [/SUP], Pooja Sharma[SUP] 6 [/SUP], Kavya Atluri[SUP] 7 [/SUP], Charuta Mandke[SUP] 8 [/SUP], Vinod Gite[SUP] 9 [/SUP], Neelam Redkar[SUP] 10 [/SUP], Mayank Chansoria[SUP] 11 [/SUP], Sumit Kumar Rawat[SUP] 12 [/SUP], Rajani S Bhat[SUP] 13 [/SUP], Ameet Dravid[SUP] 14 [/SUP], Yatin Sethi[SUP] 15 [/SUP], Chandan Barnawal[SUP] 16 [/SUP], Nirmal Kanti Sarkar[SUP] 17 [/SUP], Sunit Jariwala[SUP] 18 [/SUP], William Southern[SUP] 1 [/SUP], Yoram Puius[SUP] 19 [/SUP], MUNCO Registry
Affiliations
- PMID: 36498589
- DOI: 10.3390/jcm11237015
Abstract
Background: 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.
Methods: 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.
Results: 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, p = 0.001), history of diabetes mellitus (OR 3.5, 95% CI 1.01-11.9, p = 0.02) and a lower BMI (OR 0.9, 95% CI 0.82-0.98, p = 0.03). Mucor localized to sinus disease was associated with 77% reduced odds of death (OR = 0.23, 95% CI 0.09-0.57, p = 0.001), while cerebral mucor was associated with an increased odds of death (OR = 10.96, 95% CI 4.93-24.36, p = ≤0.0001).
Conclusion: 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.
Keywords: coronavirus; mucormycosis; steroids.