Cureus · 2026
Incidence and Progression of Acute Kidney Injury Following Head and Neck Surgeries for COVID-19-Associated Mucormycosis: A Prospective Observational Study.
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Rapeti Kalyani M, Karim Habib Md R, Panda Chinmaya K, Singh Neha, Arun T C, Arora Ripudaman
Аннотация
BACKGROUND: COVID-19-associated mucormycosis (CAM) surged because of the combination of systemic corticosteroids, poorly controlled diabetes mellitus, and altered host immunity. Rhino-orbito-cerebral mucormycosis (ROCM) requires extensive surgical debridement and systemic nephrotoxic liposomal amphotericin B (L-AMB) therapy. This study evaluated the incidence, temporal course, and association of postoperative acute kidney injury (AKI) with various clinical factors in this high-risk surgical cohort.
MATERIALS AND METHODS: This prospective observational cohort study enrolled 49 adult patients who underwent major head and neck surgical debridement for ROCM and required postoperative critical care management. We excluded patients with established renal failure. We performed and recorded serial clinical and biochemical monitoring daily over the next five days. AKI incidence and severity were staged according to Acute Kidney Injury Network (AKIN) criteria.
RESULTS: A total of 49 patients were evaluated for AKI, of which 9 developed AKI (18.4%). Patients who developed AKI had a higher mean age (56.6 ± 10.0 years versus 49.4 ± 10.3 years) and preoperative serum creatinine (1.1 ± 0.5 vs 0.9 ± 0.2 mg/dL), but these differences were not statistically significant. However, patients who developed post-operative AKI had a significantly lower estimated glomerular filtration rate (eGFR) (87.4 ± 27.1 vs 102.9 ± 17.4 mL/min/1.73 m²; p = 0.03), and a significantly higher prevalence of AKI was found in patients having pre-existing hypertension (77.8% vs. 32.5%; p = 0.02). Conversely, mean duration (p = 0.35), cumulative preoperative L-AMB dose (p = 0.319), and background diabetes mellitus (p = 0.136) did not differ significantly between groups.
CONCLUSION: AKI was noted in nearly one-fifth of patients after ROCM surgery and was more common in older patients with hypertension and poorer baseline renal function. Baseline renal function appeared more important than cumulative L-AMB exposure or diabetes, highlighting the need for early renal risk assessment and close postoperative monitoring.
MATERIALS AND METHODS: This prospective observational cohort study enrolled 49 adult patients who underwent major head and neck surgical debridement for ROCM and required postoperative critical care management. We excluded patients with established renal failure. We performed and recorded serial clinical and biochemical monitoring daily over the next five days. AKI incidence and severity were staged according to Acute Kidney Injury Network (AKIN) criteria.
RESULTS: A total of 49 patients were evaluated for AKI, of which 9 developed AKI (18.4%). Patients who developed AKI had a higher mean age (56.6 ± 10.0 years versus 49.4 ± 10.3 years) and preoperative serum creatinine (1.1 ± 0.5 vs 0.9 ± 0.2 mg/dL), but these differences were not statistically significant. However, patients who developed post-operative AKI had a significantly lower estimated glomerular filtration rate (eGFR) (87.4 ± 27.1 vs 102.9 ± 17.4 mL/min/1.73 m²; p = 0.03), and a significantly higher prevalence of AKI was found in patients having pre-existing hypertension (77.8% vs. 32.5%; p = 0.02). Conversely, mean duration (p = 0.35), cumulative preoperative L-AMB dose (p = 0.319), and background diabetes mellitus (p = 0.136) did not differ significantly between groups.
CONCLUSION: AKI was noted in nearly one-fifth of patients after ROCM surgery and was more common in older patients with hypertension and poorer baseline renal function. Baseline renal function appeared more important than cumulative L-AMB exposure or diabetes, highlighting the need for early renal risk assessment and close postoperative monitoring.