Dependability and Prognostic Value of Biomarkers in COVID-19 Associated Rhino-Orbito- Cerebral Mucormycosis- A Long Term Ambispective Study

• Published in: Indian journal of otolaryngology, and head, and neck surgery and head, and neck surgery, 2024-10, Vol.76 (5), p.4559-4568
• Main Authors: Das, K. Nidhin, Gupta, Diksha, Sharma, Vidhu, Soni, Kapil, Banerjee, Mithu, Choudhury, Bikram, Goyal, Amit
• Format: Article
• Language: English
• Subjects: Biomarkers; COVID-19; Head and Neck Surgery; Medicine; Medicine & Public Health; Mortality; Original Article; Otorhinolaryngology
• ISSN: 2231-3796; 0973-7707
• DOI: 10.1007/s12070-024-04921-3

COVID-19 pandemic, which has exhibited a wide clinical spectrum and an unexpected surge in mucormycosis cases, understanding various biomarkers’ roles becomes pivotal. As mucormycosis leads to clinical morbidity and mortality through angioinvasion and thromboembolism, unveiling the correlation between these markers and disease progression can shed light on the reasons behind mucormycosis’s emergence as an epidemic, especially following the second wave of COVID-19. This long term ambispective observational study, conducted from May 2020 to July 2023, aimed to assess specific biomarkers as predictors of severity in COVID-19-associated mucormycosis (CAM). Biomarkers measured included ESR, CRP, D-dimer, IL-8, PCT, serum ferritin, and neutrophil-lymphocyte ratio (NLR) at different time points. Data analysis employed descriptive statistics, repeated measure ANOVA, Spearman correlations, ROC curve analysis, and logistic regression. Of 290 patients, 198 completed the 2-year follow-up. Elevated baseline biomarker levels significantly decreased with treatment initiation. CRP and NLR emerged as significant predictors of severe CAM, with odds ratio 2.926 (95% CI 1.466–4.360) and 2.203 (95% CI 0.863–1.040) respectively. Factors influencing CAM progression included age, CRP, and NLR, while all biomarkers independently predicted mortality. A death prediction model using CRP, PCT, D-dimer, NLR, and IL-8 demonstrated exceptional performance, with a sensitivity of 83.1% and specificity of 100%. Elevated inflammatory markers in CAM patients showed a decline with treatment, with NLR and CRP proving crucial for predicting severity. Serial monitoring of IL-8, CRP, PCT, NLR, D-dimer, and ferritin provides insights into disease progression and prognosis. The study underscores the importance of biomarker assessment in managing CAM, especially in the context of the unpredictable clinical spectrum of COVID-19 and the subsequent mucormycosis surge.