COVID-19 Associated Mucormycosis: A Case-Control Study

BackgroundIndia has seen a surge in COVID-19 associated mucormycosis (CAM) cases during the second wave of the pandemic. We conducted a study to determine independent risk factors for CAM. MethodsWe performed a retrospective case control study in a tertiary care private hospital in Pune, India. Fifty-two cases of CAM were compared with 166 concurrent controls randomly selected from the COVID-19 admissions during the same time period. Association of demographic factors, comorbidities, cumulative steroid dose used (calculated as dexamethasone equivalent), maximum respiratory support required, use of injectable/oral anticoagulation, and use of aspirin with CAM was assessed by univariate and multivariate logistic regression. ResultsA total of 218 subjects (52 cases; 166 controls) were studied. Any diabetes (pre-existing diabetes and new onset diabetes during COVID-19) was noted in a significantly higher proportion of cases (73{middle dot}1%, 45{middle dot}8% P<0.001) and cumulative dexamethasone dose used in cases was significantly greater (97{middle dot}72 mg vs 60 mg; P=0{middle dot}016). In a multivariate regression analysis cumulate dexamethasone dose >120 mg (OR 9{middle dot}03, confidence interval 1{middle dot}75-46{middle dot}59, P=0{middle dot}009) and any diabetes (OR 4{middle dot}78, confidence interval 1{middle dot}46-15{middle dot}65, P=0{middle dot}01) were found to be risk factors for CAM. While use of anticoagulation (OR 0{middle dot}01, confidence interval 0{middle dot}00-0{middle dot}09, P<0{middle dot}001) and use of aspirin (OR 0{middle dot}02, confidence interval 0{middle dot}01-0{middle dot}07, P<0{middle dot}001) were found to be protective against CAM. ConclusionDiabetes mellitus and cumulative dose of dexamethasone greater than 120 mg (or equivalent dose of other corticosteroid) were associated with an increased risk of CAM while use of aspirin and anticoagulation were associated with a lower risk.