Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Abdulkader Rizwan Suliankatchi, Mohan Malu, Saravanakumar Divya, Ponnaiah Manickam, Bhatnagar Tarun, Devika S, Gayathri K, Rozario Amanda G A, Moorthy Aditya, Devaraja K, Saravanam Prasanna Kumar, Panigrahi Sunil Kumar, Srivastava Abhinav, Chandra Baishya Achyut, Garg Ajai, Mishra Amit Kumar, Tyagi Amit, Talukdar Anjana Jyoti, Kankaria Ankita, Bhatnagar Aparna, Karat Arathi, Kumar Arul Sundaresh, Chug Ashi, Vankudre Ashok, Ramaswamy Balakrishnan, Parmar Bhagirathsinh, Bharathi M B, Jadav Bhargav R, Unnikrishnan Bhaskaran, Karuppannasamy Divya, Medikeri Gaurav, Ghate Girija, Shah Hardik, Saha Ipsita, Ojah Jutika, Pujary Kailesh, Srivastava Kajal, Shanmugam Karthikeyan, Krishnasamy Karthikeyan, Saravu Kavitha, Sivapuram Kavya, Joshi Krupal, Singh Mahendra, Bairwa Mukesh, Muthurajesh Easwaran, Dhiwakar Muthuswamy, Das Nandini, Samagh Navneh, Dinakaran Nethra, Borugadda Niharika, Gupta Nikhil, Gupta Nitin, Nagarkar Nitin Madhusudan, Solanki Nitinkumar, Sharma Parul, Parida Pradipta, Panda PrasanKumar, Kulkarni Praveen, Bacchalli Prithvi, Priya Sivasubramanian, Patil Pushpa, Shanbag Raghunath, Bagla Rahul Kumar, Patil Rajashri, Avuluri Rajesh Kumar, Patil Rakesh, Vijhayaraghavan Ramanikanth, Hanumantappa Ramesh, Duraisamy Ramesh, Rathinavel Andiappan, Melkundi Renuka S, Saxena Rita Singh, Mandal Salil Kumar, Pandharinath Sanjay Kishve, Varghese Thomas Sara, Satpute Satish, Sarkar Saurav, Narayanan Seetharaman, Thakur Shalini, Jahagirdar Shubhashri, Patil Siddaram, Dube Simmi, Lakshamanan Somu, Rao Srinivas D, Sumathi V, Darivemula Surendra Babu, Nayak Tulasi, Dixit Umesh, Saini Vaibhav, Backiavathy Varsha, Shenoy Vijendra, Hallur Vinay Kumar, Murhekar Manoj V, Singh Ambesh, Muthalik Anirudha Vijay, Semwal Ankita, Raj Anuradha, Singh Arvind, Kumar Arvind, Haarika Basanta, Adhikary Bijan, Kaswala Chintan, Madi Deepak, Haldipur Deepak, Palal Deepu, Solanki Dharmendra, Samal Dillip Kumar, Sohkhlet Gracia, Kaur Harmeet, Shanmugam Jeevithan, Singh Kalpana, Muthuraman Kannan, Rajendran Kathiravan, Patil Kavita, Kudlu Kshithi, Krishnan Lakshmi, Dutta Mainak, Vijayageetha Mathavaswami, Rathod Mehul, Jayakumar Naveen Kumar, Patel Nirmal, Arthur Preetam, Kale Preeti, Dwivedi Preksha, Puja J, Ninama Rakesh, Rathinamoorthy Ramesh, Arora Ripu Daman, Patel Rushika, Mukhida Sahjid, Krishnaja Kanakaveti Sai Sri, Rajamanickam Saranya, Verma Sarthak, Senthilnathan K P, Varadarajan Seshadri, Shivalingappa Shivakumar Swamy, Kalhan Shivani, Kancherla Srinithya, Kumar Srinivasa P V, Chinnappan Vaishnavi, Goel Varun, Gupta Vikasdeep, All-India Mucormycosis Consortium
Аннотация
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.