Risk factors for COVID-19 associated Mucormycosis (the result of the registry data)

Author:

Sofya Khostelidi1,2, N.N.Klimko1,2

Author address:

1. Department of Clinical Mycology, Allergy and Immunology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg (RU) 2. Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg (RU)

Abstract:

Objectives. To study mucormycosis risk factors in patients with COVID-19 (the analysis of the registered database of rare invasive mycoses).
Methods. We used registry of patients with mucormycosis. That registry formed by Department of Clinical Mycology, Allergy and Immunology and Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov. We used international criteria for diagnosis (EORTC/MSGERC 20192020). We performed an odds ratio (OR) calculation to assess the relationship between risk factors and mucormycosis.
Results. In our registry, we included 97 patients with Covid-associated mucormycosis (57% men, 43% women), the median age was 62 years [±11.5 years]. The control group consisted of 97 patients with COVID-19 without mucormycosis (men – 58%, women – 42%, median age – 62 years [±12.6 years].
The underlying disease in COVID-M patients were: diabetes mellitus – 78% (60% – new-onset) with an average glucose level of 15.9 mmol/l, obesity grade 32%, hematological condition in remission 4%, chronic polysinusitis 2%, COPD 1%.In both groups of patients used glucocorticosteroids (GCS) (98% vs 90%). The median dose of GCS (in terms of prednisolone) in patients with COVID-19 was 90 mg/day, in patients with COVID-M -140 mg/day. If patients used GCS 100 mg/day (more than 1 mg/kg/day) ≥10 days the risk of developing mucormycosis increased OR=23.7. Diabetic ketoacidosis developed more often in patients with COVID-19 (32% vs 2%, p=0.0004). The risk of developing mucormycosis with ketoacidosis increased OR=22.3. The risk of developing COVID-M increased in patients with lymphocytopenia (if the duration of lymphocytopenia was 10 days or more OR=2.9). Оther background states COVID-M patients: ICU units (9% vs 47%), mechanical ventilation (7% vs 20%), аgranulocytosis (2% vs 12%). In patients with COVID-M, coronavirus infection was mild in 24% of cases, and moderate and severe in 38% of cases. In the control group 12%, 40% and 48% (p˃0.05).
Сonclusion: the main risk factors for Covid-associated mucormycosis – diabetic ketoacidosis and high doses of glucocorticosteroids.

Abstract Number: 16

Conference Year: 2024

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