PDF(Pubmed)
Abstract：
Background: The coronavirus disease 2019 (COVID-19) pandemic was associated with an increased incidence of mucormycosis globally. However, the clinical pattern, epidemiologic features and risk factors for adverse outcomes are not well established. Methods: We performed a retrospective analysis of the data from patients hospitalized with proven mucormycosis between April 2021 and August 2021. Patients were managed with a multi-disciplinary approach involving medical, surgical, and comorbidity treatment. The clinical presentation, management details, complications and outcomes, including mortality, were reviewed from clinical records. Results: The mean age of presentation was 53.7 (± 11.8) years, and 88 (84.6%) were men. Of the 104 cases with COVID-19-associated mucormycosis, 97 (93.27%) patients had diabetes, and 80.8% had a haemoglobin A1C (HbA1c) of ≥6.4% at diagnosis. Seventy percent of diabetes cases experienced steroid-induced hyperglycaemia during treatment. Even with appropriate treatment, 17 (16.35%) patients died. High HbA1c and creatinine levels, presence of chronic kidney disease (CKD), need for intensive care unit admission, and orbital evisceration were the risk factors associated with high mortality on multivariate logistic regression analysis. Cox regression analysis revealed that the overall mortality increased by a factor of 12% with each 1 percentage point increase in HbA1c ≥6.4% (hazard ratio 1.12; 95% confidence interval 0.95- 1.31). The mortality risk was even higher when diabetes was associated with CKD (hazard ratio 1.82; 95% confidence interval 0.24-14.00). Conclusion: High HbA1c and creatinine levels, intensive care unit admission, CKD, and aggressive disease requiring orbital evisceration are the predictors of mortality in patients with COVID-19-associated mucormycosis. Patients with these risk factors should be managed more actively to reduce morbidity and mortality.
摘要：
背景：2019年冠状病毒病（COVID-19）大流行与全球毛霉菌病发病率增加有关。然而,临床模式，不良结局的流行病学特征和危险因素尚不明确.方法：我们对2021年4月至2021年8月间确诊毛霉菌病住院患者的资料进行回顾性分析。患者采用涉及医学的多学科方法进行管理，外科,和合并症治疗。临床表现，管理细节，并发症和结果，包括死亡率,从临床记录中审查。结果：报告的平均年龄为53.7（±11.8）岁，男性88人(84.6%)。在104例COVID-19相关毛霉菌病中，97例（93.27%）患者患有糖尿病，80.8%的患者在诊断时血红蛋白A1C(HbA1c)≥6.4%。70％的糖尿病病例在治疗期间经历了类固醇诱导的高血糖症。即使经过适当的治疗，17例（16.35%）患者死亡。高HbA1c和肌酐水平，慢性肾脏病（CKD）的存在，需要入住重症监护室，在多因素logistic回归分析中,眼眶摘除是与高死亡率相关的危险因素.Cox回归分析显示，随着HbA1c≥6.4%每增加1个百分点，总死亡率增加12%（风险比1.12；95%置信区间0.95-1.31）。当糖尿病与CKD相关时，死亡风险甚至更高（风险比1.82；95％置信区间0.24-14.00）。结论：高HbA1c和肌酐水平，重症监护室入院,CKD,需要眼眶切除的侵袭性疾病是COVID-19相关性毛霉菌病患者死亡率的预测因子。具有这些危险因素的患者应更积极地管理以降低发病率和死亡率。
