Clinical and surgical factors affecting the prognosis and survival rates in patients with mucormycosis

Abstract

Purpose: To investigate the factors affecting disease specific mortality (DSM) in patients with mucormycosis.

Methods: This retrospective study included 24 patients diagnosed with mucormycosis and who had undergone surgical and medical treatment between 2010 and 2020. There were 14 male and 10 female patients whose mean age was 53.70 ± 16.87 years, range 18-83. We reviewed the factors affecting DSM, including the extent of disease (paranasal sinus, palatal, orbital or intracranial involvement) and blood parameters (BP) that are serum glucose level (SGL), white blood cell, neutrophil, lymphocyte counts, C-reactive protein and hemoglobulin levels. Also, the effect of SGL in diabetes mellitus and BP in hematological malignancies on DSM was additionally evaluated.

Results: Orbital (p = 0.001) and intracranial (p < 0.01) involvement had statistically significant effect on DSM but not the palatal involvement. When Cox regression analysis was employed to analyze the effect of multiple independent factors on DSM, only the extent of disease (p = 0.023) had statistically significant effect. Receiver operating characteristic analysis of SGL for diabetic patients demonstrated that the area under the curve was 0.917 (p = 0.016). A cut-off SGL of 360 mg/dl revealed an 83.3% sensitivity and 83.3% specificity for mortality outcome for diabetic patients having mucormycosis.

Conclusion: Orbital or cerebral involvement is related to a poor prognosis, so early endoscopic nasal examination, diagnosis and treatment are of vital importance for DSM in mucormycosis. Serum glucose level over 360 mg/dl in uncontrolled diabetic patients with fever, ophthalmological findings and facial hypoesthesia should necessitate a consultation to an otolaryngologist and an endoscopic careful nasal examination.

Keywords: Diabetes mellitus; Hematologic malignancy; Invasive fungal rhinosinusitis; Mortality; Mucormycosis; Prognosis.