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. 2025 Jun 12:S1198-743X(25)00286-1.
doi: 10.1016/j.cmi.2025.06.001. Online ahead of print.

Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study

Rizwan Suliankatchi Abdulkader  1 , Malu Mohan  2 , Divya Saravanakumar  3 , Manickam Ponnaiah  4 , Tarun Bhatnagar  5 , S Devika  5 , K Gayathri  5 , Amanda G A Rozario  6 , Aditya Moorthy  7 , K Devaraja  8 , Prasanna Kumar Saravanam  9 , Sunil Kumar Panigrahi  10 , Abhinav Srivastava  11 , Achyut Chandra Baishya  12 , Ajai Garg  13 , Amit Kumar Mishra  14 , Amit Tyagi  15 , Anjana Jyoti Talukdar  12 , Ankita Kankaria  16 , Aparna Bhatnagar  17 , Arathi Karat  18 , Arul Sundaresh Kumar  19 , Ashi Chug  20 , Ashok Vankudre  21 , Balakrishnan Ramaswamy  8 , Bhagirathsinh Parmar  22 , M B Bharathi  23 , Bhargav R Jadav  24 , Bhaskaran Unnikrishnan  25 , Divya Karuppannasamy  26 , Gaurav Medikeri  27 , Girija Ghate  28 , Hardik Shah  22 , Ipsita Saha  29 , Jutika Ojah  12 , Kailesh Pujary  8 , Kajal Srivastava  30 , Karthikeyan Shanmugam  31 , Karthikeyan Krishnasamy  32 , Kavitha Saravu  33 , Kavya Sivapuram  23 , Krupal Joshi  34 , Mahendra Singh  35 , Mukesh Bairwa  36 , Easwaran Muthurajesh  37 , Muthuswamy Dhiwakar  38 , Nandini Das  39 , Navneh Samagh  40 , Nethra Dinakaran  9 , Niharika Borugadda  41 , Nikhil Gupta  42 , Nitin Gupta  33 , Nitin Madhusudan Nagarkar  43 , Nitinkumar Solanki  44 , Parul Sharma  44 , Pradipta Parida  45 , PrasanKumar Panda  36 , Praveen Kulkarni  46 , Prithvi Bacchalli  7 , Sivasubramanian Priya  37 , Pushpa Patil  47 , Raghunath Shanbag  48 , Rahul Kumar Bagla  11 , Rajashri Patil  30 , Rajesh Kumar Avuluri  49 , Rakesh Patil  50 , Ramanikanth Vijhayaraghavan  38 , Ramesh Hanumantappa  51 , Ramesh Duraisamy  52 , Andiappan Rathinavel  53 , Renuka S Melkundi  54 , Rita Singh Saxena  42 , Salil Kumar Mandal  55 , Sanjay Kishve Pandharinath  56 , Sara Varghese Thomas  38 , Satish Satpute  57 , Saurav Sarkar  45 , Seetharaman Narayanan  58 , Shalini Thakur  59 , Shubhashri Jahagirdar  60 , Siddaram Patil  54 , Simmi Dube  42 , Somu Lakshamanan  9 , Srinivas D Rao  41 , V Sumathi  52 , Surendra Babu Darivemula  61 , Tulasi Nayak  7 , Umesh Dixit  47 , Vaibhav Saini  62 , Varsha Backiavathy  63 , Vijendra Shenoy  64 , Vinay Kumar Hallur  65 , Manoj V Murhekar  66 , Ambesh Singh  57 , Anirudha Vijay Muthalik  58 , Ankita Semwal  15 , Anuradha Raj  67 , Arvind Singh  68 , Arvind Kumar  42 , Basanta Haarika  69 , Bijan Adhikary  70 , Chintan Kaswala  71 , Deepak Madi  72 , Deepak Haldipur  73 , Deepu Palal  30 , Dharmendra Solanki  24 , Dillip Kumar Samal  54 , Gracia Sohkhlet  74 , Harmeet Kaur  75 , Jeevithan Shanmugam  76 , Kalpana Singh  21 , Kannan Muthuraman  37 , Kathiravan Rajendran  31 , Kavita Patil  77 , Kshithi Kudlu  64 , Lakshmi Krishnan  78 , Mainak Dutta  79 , Mathavaswami Vijayageetha  80 , Mehul Rathod  24 , Naveen Kumar Jayakumar  81 , Nirmal Patel  22 , Preetam Arthur  82 , Preeti Kale  83 , Preksha Dwivedi  84 , J Puja  85 , Rakesh Ninama  44 , Ramesh Rathinamoorthy  58 , Ripu Daman Arora  57 , Rushika Patel  86 , Sahjid Mukhida  87 , Sai Sri Krishnaja Kanakaveti  31 , Saranya Rajamanickam  31 , Sarthak Verma  88 , K P Senthilnathan  89 , Seshadri Varadarajan  90 , Shivakumar Swamy Shivalingappa  91 , Shivani Kalhan  92 , Srinithya Kancherla  93 , Srinivasa P V Kumar  41 , Vaishnavi Chinnappan  31 , Varun Goel  94 , Vikasdeep Gupta  62 ; All-India Mucormycosis Consortium
Affiliations

Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study

Rizwan Suliankatchi Abdulkader et al. Clin Microbiol Infect. .

Abstract

Objectives: We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalized with mucormycosis.

Methods: This prospective, multicentre cohort study included patients hospitalized for mucormycosis across 26 sites in India from March to July 2021. Follow-up data were collected at 1-, 3-, 6-, and 12-month intervals post-discharge through telephonic or in-person interviews with patients or caregivers. Primary outcomes were survival, sequelae, and quality of life, assessed using the EURO-QOL 5D-5L scale. Survival analyses were performed using the shared frailty Cox proportional hazards model for predefined subgroups. Additional sensitivity analyses using inverse probability of censoring weights and marginal structural modelling were conducted to account for loss to follow-up and the time-varying nature of the treatment and confounders.

Results: Of the 686 patients, 101 deaths (14.7%) occurred within 1 year, with a median survival time of 230 days. The majority of deaths (64.3%) occurred early, i.e. during hospitalization. Independent predictors of mortality included orbit involvement (hazard ratio [HR]: 2.0, 95% CI: 1.2-3.4), intracranial/cerebral involvement (HR: 2.6, 95% CI: 1.5-4.4), admission to an intensive care unit (HR: 6.4, 95% CI: 3.5-11.6), poor glycaemic control (HR: 2.3, 95% CI: 1.1-4.7), and other comorbidities (HR: 1.6, 95% CI: 1.0-2.5), and those associated with lower mortality were combination antifungal therapy (HR: 0.2, 95% CI: 0.1-0.4) and receipt of surgical treatment (HR: 0.1, 95% CI: 0.07-0.2). Survivors demonstrated improved quality of life, especially those who were gainfully employed. Sensitivity analysis indicated no major impact of loss to follow-up on survival.

Discussion: Poor glycaemic control, severe disease, and involvement of the orbit or intracranial/cerebral regions predict higher mortality in mucormycosis. Aggressive therapeutic strategies, including combination of antifungal therapy and surgical interventions, substantially improved survival. The study highlights the importance of integrating psychological rehabilitation and socioeconomic support into management protocols to enhance the quality of life among survivors.

Keywords: Antifungal therapy; Cohort; Disability; Mortality; Mucormycosis.

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