Importance An outbreak of COVID-19–associated rhino-orbitocerebral mucormycosis (CAM) has occurred in many parts of the world. Although the clinical profile and risk factors for CAM have been studied, cumulative mortality and its risk factors have not.

Objective To report the cumulative mortality rates at different times in cases with CAM and identify risk factors for CAM-associated mortality.

Design, Setting, and Participants This retrospective case-control study was conducted from March 1 to May 30, 2021, in a tertiary care multispecialty hospital in western India. All patients diagnosed with CAM and with a minimum follow-up of 30 days or those who died before 30 days due to CAM were included.

Main Outcomes and Measure Cumulative mortality in CAM using survival analysis.

Results A total of 73 consecutive patients with CAM with a mean (SD) age of 53.5 (12.5) years were included in the analysis, of whom 48 (66%) were men. CAM developed at a median of 28 (IQR, 15-45; range, 4-90) days after recovery from COVID-19. Of the 73 patients with CAM, 26 (36%) died; the cumulative probability of death was 26% (95% CI, 16%-41%) at day 7 and doubled to 53% (95% CI, 39%-69%) at day 21. Sinus debridement was performed in 18 of 51 patients (35%), and 5 of 52 (10%) underwent exenteration, whereas intravenous lyophilized amphotericin B was administered to 48 patients (66%). A multivariate Cox proportional hazards regression analysis showed that receiving mechanical ventilation in the past was associated with a nearly 9-fold increased risk of death (hazard ratio [HR], 8.98; 95% CI, 2.13-38.65; P = .003), and patients who had visual acuity of light perception or better had a 46% lower risk of death (HR, 0.56; 95% CI, 0.32-0.98; P = .04). Intravenous amphotericin B administration was associated with a reduced rate of exenteration (0 vs 5 of 25 [20%]; P < .001). On multivariate analysis, those who received intravenous amphotericin B had a 69% reduced risk of death (HR, 0.31; 95% CI, 0.06-1.43; P = .13).

Conclusions and Relevance These findings suggest that the mortality rate after rhino-orbitocerebral mucormycosis is high and that a subgroup of patients with severe COVID-19 or presenting with severe orbital disease are more likely to die within 10 days of admission.

重要性 世界许多地方都爆发了与 COVID-19 相关的犀牛-眼眶脑毛霉菌病 (CAM)。虽然已经研究了 CAM 的临床特征和危险因素，但尚未研究累积死亡率及其危险因素。

目的 报告 CAM 病例在不同时间的累积死亡率，并确定 CAM 相关死亡率的危险因素。

设计、地点和参与者 这项回顾性病例对照研究于 2021 年 3 月 1 日至 5 月 30 日在印度西部的一家三级护理多专科医院进行。所有被诊断患有 CAM 且至少随访 30 天或因 CAM 在 30 天前死亡的患者均被纳入。

使用生存分析的 CAM 中的主要结果和测量累积死亡率。

结果 共有 73 名平均 (SD) 年龄为 53.5 (12.5) 岁的连续 CAM 患者被纳入分析，其中 48 名 (66%) 为男性。从 COVID-19 恢复后，CAM 的中位数为 28（IQR，15-45；范围，4-90）天。在 73 名 CAM 患者中，26 名 (36%) 死亡；累计死亡概率在第 7 天为 26%（95% CI，16%-41%），在第 21 天翻倍至 53%（95% CI，39%-69%）。51 例患者中有 18 例进行了鼻窦清创术患者 (35%)，52 名患者中有 5 名 (10%) 接受了肠切除术，而 48 名患者 (66%) 接受了静脉注射冻干两性霉素 B。多变量 Cox 比例风险回归分析表明，过去接受机械通气与死亡风险增加近 9 倍相关（风险比 [HR]，8.98；95% CI，2.13-38.65；P = .003），光感视力或更好的患者死亡风险降低 46%（HR，0.56；95% CI，0.32-0.98；P  = .04）。静脉注射两性霉素 B 与减低肠外廓清率有关（0 对 25 例中的 5 例 [20%]；P  < .001）。在多变量分析中，接受静脉注射两性霉素 B 的患者死亡风险降低了 69%（HR，0.31；95% CI，0.06-1.43；P  = .13）。

结论和相关性 这些研究结果表明，鼻-眼眶脑毛霉菌病后的死亡率很高，并且患有严重 COVID-19 或出现严重眼眶疾病的患者亚组更有可能在入院后 10 天内死亡。