COVID-19 ASSOCIATED MUCORMYCOSIS: A CASE-CONTROL STUDY

  1. Dulari Gupta
  2. Rahul Kulkarni
  3. Shripad Pujari
  4. Atul Mulay

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Abstract

Background

India 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.

Methods

We 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.

Results

A 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 (73·1%, 45·8% P<0.001) and cumulative dexamethasone dose used in cases was significantly greater (97·72 mg vs 60 mg; P=0·016). In a multivariate regression analysis cumulate dexamethasone dose >120 mg (OR 9·03, confidence interval 1·75-46·59, P=0·009) and any diabetes (OR 4·78, confidence interval 1·46-15·65, P=0·01) were found to be risk factors for CAM. While use of anticoagulation (OR 0·01, confidence interval 0·00-0·09, P<0·001) and use of aspirin (OR 0·02, confidence interval 0·01-0·07, P<0·001) were found to be protective against CAM.

Conclusion

Diabetes 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.

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  1. ScreenIT

    SciScore for 10.1101/2021.08.16.21262109: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIACUC: The study was approved by the Institutional Ethics Committee.
    Sex as a biological variablenot detected.
    RandomizationFrom this list, three random controls were selected for each patient with mucormycosis using randomly generated numbers.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS version 26 (SPSS for Windows, Chicago, SPSS Inc).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.08.16.21262109 on medRxiv