Volume 29, Number 1—January 2023
CME ACTIVITY - Synopsis
Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India
Table 1
Baseline features of CAM case-patients and COVID-19 control-patients at admission for COVID-19, India, January–June 2021*
Category | Controls, n = 3,911 | CAM, n = 1,733 | p value |
---|---|---|---|
Age, y, mean (SD) |
52.7 (13.5) |
52.6 (12.5) |
0.66 |
Male sex |
2,738/3,911 (70.0) |
1,285/1,733 (74.1) |
0.002 |
Rural residence, n = 3,924 |
309/2,615 (11.8) |
360/1,309 (27.5) |
0.0001 |
Risk factors for mucormycosis | 0.0001 | ||
None | 2,076/3,911 (53.1) | 316/1,733 (18.2) | |
1 risk factor | 1,743/3,911 (44.5) | 1,374/1,733 (79.3) | |
>1 risk factors |
92/3,911 (2.4) |
43/1,733 (2.5) |
|
Details of potential risk factors for mucormycosis† | |||
Diabetes mellitus | 1,763/3,911 (45.1) | 1,402/1,733 (80.9) | 0.0001 |
Hyperglycemia at admission, n = 5,236 | 998/3,625 (27.5) | 758/1,611 (47.1) | 0.0001 |
Plasma glucose at admission, mg/dL, mean (SD), n = 3,487 | 195 (94) | 235 (106) | 0.0001 |
Glycated hemoglobin, mean (SD), n = 1,856 | 7.7 (2.5) | 10.1 (2.9) | 0.0001 |
Duration of diabetes, y, mean (SD), n = 861 | 9.6 (9.5) | 8.4 (6.8) | 0.04 |
Recent onset of diabetes mellitus | 319/1,763 (18.1) | 246/1,402 (17.5) | 0.66 |
DKA at the time of admission for COVID-19 | 48/1,763 (2.7) | 73/1,402 (5.2) | 0.0003 |
Renal transplant | 36/3,911 (0.9) | 31/1,733 (1.8) | 0.005 |
Bone marrow transplant | 0/3,911 (0) | 1/1,733 (0.1) | 0.31 |
Hematological malignancy | 36/3,911 (0.9) | 6/1,733 (0.3) | 0.02 |
Immunosuppressive therapy | 76/3,911 (1.9) | 22/1,733 (1.3) | 0.07 |
HIV | 7/3,911 (0.2) | 6/1,733 (0.3) | 0.23 |
Others‡ |
2/3,911 (0.0) |
2/1,733 (0.1) |
0.23 |
Comorbidities | |||
Any comorbidity | 828/3,911 (21.5) | 265/1,733 (15.3) | 0.0001 |
Coronary artery disease | 285/3,911 (7.3) | 126/1,733 (7.3) | 0.98 |
Chronic kidney disease | 284/3,911 (7.3) | 98/1,733 (5.7) | 0.03 |
Chronic heart failure | 59/3,911 (1.5) | 17/1,733 (1.0) | 0.11 |
Chronic liver disease | 71/3,911 (1.8) | 13/1,733 (0.8) | 0.002 |
Chronic respiratory disease | 104/3,911 (2.7) | 17/1,733 (1.0) | 0.0001 |
Others§ |
151/3,911 (3.9) |
35/1,733 (2.0) |
0.0001 |
Laboratory parameters during COVID-19 illness | |||
Hemoglobin, g/dL, mean (SD), n = 4,506 | 12.2 (2.4) | 12.1 (2.2) | 0.11 |
Total leukocyte count, cells/µL, mean (SD), n = 4,501 | 9,853 (6,844) | 11,396 (6,110) | 0.0001 |
Median absolute lymphocyte count, cells/µL (IQR), n = 4,129 | 1,135 (720–1,706) | 1,275 (803–1,833) | 0.0001 |
Median absolute neutrophil count, cells/µL (IQR), n = 4,071 | 6,177 (3,658–10,244) | 7,858 (4,943–11,867) | 0.0001 |
Median NLR (IQR), n = 4,061 | 5.5 (2.7–11.4) | 5.7 (3.2–11.7) | 0.04 |
Platelet count, × 103/µL, mean (SD), n = 4,454 | 222 (107) | 240 (105) | 0.0001 |
Median C-reactive protein mg/dL (IQR), n = 3,972 | 26.7 (8.4–79.3) | 48.8 (20–102.5) | 0.0001 |
Median serum ferritin, µg/L (IQR) n = 3,168 |
454 (189–977) |
580 (238–1,052) |
0.02 |
Details of COVID-19 illness | |||
Hypoxemia, n = 5,476 | 2,100/3,851 (54.5) | 751/1,625(46.2) | 0.0001 |
ICU admission, n = 5,425 | 1,551/3,809 (40.7) | 331/1,616 (20.5) | 0.0001 |
Mechanical ventilation, n = 5,376 |
1,126/3,765 (29.9) |
153/1,611 (9.5) |
0.0001 |
Management during COVID-19 | |||
Glucocorticoid therapy, n = 5,431 | 2,690/3,827 (70.3) | 1,200/1,604 (74.8) | 0.001 |
Glucocorticoid use in the absence of hypoxemia, n = 5,021 | 789/3,532 (22.3) | 509/1,489 (34.2) | 0.0001 |
Median cumulative dose of glucocorticoids in milligram equivalent of dexamethasone (IQR), n = 2,809 | 52.8 (30–84) | 62.6 (30.2–120) | 0.0001 |
Median no. days on glucocorticoid treatment (IQR), n = 2,887 | 8 (5–12) | 10 (6.3–14) | 0.0001 |
Zinc supplementation, n = 5,179 | 1,502/3,633 (41.3) | 741/1,546 (47.9) | 0.0001 |
Remdesivir, n = 5,167 | 1,785/3,631 (49.2) | 317/1,536 (20.6) | 0.0001 |
Tocilizumab, n = 5,167 | 72/3,631 (2.0) | 37/1,536 (2.4) | 0.41 |
Baricitinib, n = 5,167 | 38/3,631 (1.0) | 13/1,536 (0.8) | 0.50 |
Antibacterial therapy, n = 5,396 | 2,467/3,841 (64.2) | 952/1,555 (61.2) | 0.04 |
Antifungal therapy before CAM, n = 5,039 | 174/3,513 (5.0) | 68/1,526 (4.5) | 0.45 |
*Values are no. observed/total no. (%) unless otherwise indicated. CAM, COVID-19–associated mucormycosis; DKA, diabetic ketoacidosis; DM, diabetes mellitus; ICU, intensive care unit; IQR, interquartile range; NLR, neutrophil-to-lymphocyte ratio. †A single person might have had >1 risk factor; hence the numbers do not sum to 5,644. ‡Others include neutropenia (n = 3) and primary immunodeficiency (n = 1). §Others include neurologic, endocrinologic, and rheumatologic illnesses.
1These senior authors contributed equally to this article.