{"title":"毛霉病患者的生存和生活质量：一项多中心双视角队列研究。","authors":"Rizwan Suliankatchi Abdulkader, Malu Mohan, Divya Saravanakumar, Manickam Ponnaiah, Tarun Bhatnagar, S Devika, K Gayathri, Amanda G A Rozario, Aditya Moorthy, K Devaraja, Prasanna Kumar Saravanam, Sunil Kumar Panigrahi, Abhinav Srivastava, Achyut Chandra Baishya, Ajai Garg, Amit Kumar Mishra, Amit Tyagi, Anjana Jyoti Talukdar, Ankita Kankaria, Aparna Bhatnagar, Arathi Karat, Arul Sundaresh Kumar, Ashi Chug, Ashok Vankudre, Balakrishnan Ramaswamy, Bhagirathsinh Parmar, M B Bharathi, Bhargav R Jadav, Bhaskaran Unnikrishnan, Divya Karuppannasamy, Gaurav Medikeri, Girija Ghate, Hardik Shah, Ipsita Saha, Jutika Ojah, Kailesh Pujary, Kajal Srivastava, Karthikeyan Shanmugam, Karthikeyan Krishnasamy, Kavitha Saravu, Kavya Sivapuram, Krupal Joshi, Mahendra Singh, Mukesh Bairwa, Easwaran Muthurajesh, Muthuswamy Dhiwakar, Nandini Das, Navneh Samagh, Nethra Dinakaran, Niharika Borugadda, Nikhil Gupta, Nitin Gupta, Nitin Madhusudan Nagarkar, Nitinkumar Solanki, Parul Sharma, Pradipta Parida, PrasanKumar Panda, Praveen Kulkarni, Prithvi Bacchalli, Sivasubramanian Priya, Pushpa Patil, Raghunath Shanbag, Rahul Kumar Bagla, Rajashri Patil, Rajesh Kumar Avuluri, Rakesh Patil, Ramanikanth Vijhayaraghavan, Ramesh Hanumantappa, Ramesh Duraisamy, Andiappan Rathinavel, Renuka S Melkundi, Rita Singh Saxena, Salil Kumar Mandal, Sanjay Kishve Pandharinath, Sara Varghese Thomas, Satish Satpute, Saurav Sarkar, Seetharaman Narayanan, Shalini Thakur, Shubhashri Jahagirdar, Siddaram Patil, Simmi Dube, Somu Lakshamanan, Srinivas D Rao, V Sumathi, Surendra Babu Darivemula, Tulasi Nayak, Umesh Dixit, Vaibhav Saini, Varsha Backiavathy, Vijendra Shenoy, Vinay Kumar Hallur, Manoj V Murhekar, Ambesh Singh, Anirudha Vijay Muthalik, Ankita Semwal, Anuradha Raj, Arvind Singh, Arvind Kumar, Basanta Haarika, Bijan Adhikary, Chintan Kaswala, Deepak Madi, Deepak Haldipur, Deepu Palal, Dharmendra Solanki, Dillip Kumar Samal, Gracia Sohkhlet, Harmeet Kaur, Jeevithan Shanmugam, Kalpana Singh, Kannan Muthuraman, Kathiravan Rajendran, Kavita Patil, Kshithi Kudlu, Lakshmi Krishnan, Mainak Dutta, Mathavaswami Vijayageetha, Mehul Rathod, Naveen Kumar Jayakumar, Nirmal Patel, Preetam Arthur, Preeti Kale, Preksha Dwivedi, J Puja, Rakesh Ninama, Ramesh Rathinamoorthy, Ripu Daman Arora, Rushika Patel, Sahjid Mukhida, Sai Sri Krishnaja Kanakaveti, Saranya Rajamanickam, Sarthak Verma, K P Senthilnathan, Seshadri Varadarajan, Shivakumar Swamy Shivalingappa, Shivani Kalhan, Srinithya Kancherla, Srinivasa P V Kumar, Vaishnavi Chinnappan, Varun Goel, Vikasdeep Gupta","doi":"10.1016/j.cmi.2025.06.001","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalized with mucormycosis.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study.\",\"authors\":\"Rizwan Suliankatchi Abdulkader, Malu Mohan, Divya Saravanakumar, Manickam Ponnaiah, Tarun Bhatnagar, S Devika, K Gayathri, Amanda G A Rozario, Aditya Moorthy, K Devaraja, Prasanna Kumar Saravanam, Sunil Kumar Panigrahi, Abhinav Srivastava, Achyut Chandra Baishya, Ajai Garg, Amit Kumar Mishra, Amit Tyagi, Anjana Jyoti Talukdar, Ankita Kankaria, Aparna Bhatnagar, Arathi Karat, Arul Sundaresh Kumar, Ashi Chug, Ashok Vankudre, Balakrishnan Ramaswamy, Bhagirathsinh Parmar, M B Bharathi, Bhargav R Jadav, Bhaskaran Unnikrishnan, Divya Karuppannasamy, Gaurav Medikeri, Girija Ghate, Hardik Shah, Ipsita Saha, Jutika Ojah, Kailesh Pujary, Kajal Srivastava, Karthikeyan Shanmugam, Karthikeyan Krishnasamy, Kavitha Saravu, Kavya Sivapuram, Krupal Joshi, Mahendra Singh, Mukesh Bairwa, Easwaran Muthurajesh, Muthuswamy Dhiwakar, Nandini Das, Navneh Samagh, Nethra Dinakaran, Niharika Borugadda, Nikhil Gupta, Nitin Gupta, Nitin Madhusudan Nagarkar, Nitinkumar Solanki, Parul Sharma, Pradipta Parida, PrasanKumar Panda, Praveen Kulkarni, Prithvi Bacchalli, Sivasubramanian Priya, Pushpa Patil, Raghunath Shanbag, Rahul Kumar Bagla, Rajashri Patil, Rajesh Kumar Avuluri, Rakesh Patil, Ramanikanth Vijhayaraghavan, Ramesh Hanumantappa, Ramesh Duraisamy, Andiappan Rathinavel, Renuka S Melkundi, Rita Singh Saxena, Salil Kumar Mandal, Sanjay Kishve Pandharinath, Sara Varghese Thomas, Satish Satpute, Saurav Sarkar, Seetharaman Narayanan, Shalini Thakur, Shubhashri Jahagirdar, Siddaram Patil, Simmi Dube, Somu Lakshamanan, Srinivas D Rao, V Sumathi, Surendra Babu Darivemula, Tulasi Nayak, Umesh Dixit, Vaibhav Saini, Varsha Backiavathy, Vijendra Shenoy, Vinay Kumar Hallur, Manoj V Murhekar, Ambesh Singh, Anirudha Vijay Muthalik, Ankita Semwal, Anuradha Raj, Arvind Singh, Arvind Kumar, Basanta Haarika, Bijan Adhikary, Chintan Kaswala, Deepak Madi, Deepak Haldipur, Deepu Palal, Dharmendra Solanki, Dillip Kumar Samal, Gracia Sohkhlet, Harmeet Kaur, Jeevithan Shanmugam, Kalpana Singh, Kannan Muthuraman, Kathiravan Rajendran, Kavita Patil, Kshithi Kudlu, Lakshmi Krishnan, Mainak Dutta, Mathavaswami Vijayageetha, Mehul Rathod, Naveen Kumar Jayakumar, Nirmal Patel, Preetam Arthur, Preeti Kale, Preksha Dwivedi, J Puja, Rakesh Ninama, Ramesh Rathinamoorthy, Ripu Daman Arora, Rushika Patel, Sahjid Mukhida, Sai Sri Krishnaja Kanakaveti, Saranya Rajamanickam, Sarthak Verma, K P Senthilnathan, Seshadri Varadarajan, Shivakumar Swamy Shivalingappa, Shivani Kalhan, Srinithya Kancherla, Srinivasa P V Kumar, Vaishnavi Chinnappan, Varun Goel, Vikasdeep Gupta\",\"doi\":\"10.1016/j.cmi.2025.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalized with mucormycosis.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p>\",\"PeriodicalId\":10444,\"journal\":{\"name\":\"Clinical Microbiology and Infection\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2025-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Microbiology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cmi.2025.06.001\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cmi.2025.06.001","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study.
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.
期刊介绍：
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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