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

K Nidhin Das; Diksha Gupta; Vidhu Sharma; Kapil Soni; Mithu Banerjee; Bikram Choudhury; Amit Goyal

doi:10.1007/s12070-024-04921-3

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

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4559-4568. doi: 10.1007/s12070-024-04921-3. Epub 2024 Jul 27.

Authors

K Nidhin Das¹, Diksha Gupta¹, Vidhu Sharma¹, Kapil Soni¹, Mithu Banerjee², Bikram Choudhury¹, Amit Goyal¹

Affiliations

¹ Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India.
² Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India.

PMID: 39376422
PMCID: PMC11456141 (available on 2025-10-01)
DOI: 10.1007/s12070-024-04921-3

Abstract

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.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-04921-3.

Keywords: Biomarkers; COVID-19 associated mucormycosis; Inflammatory markers; Long term outcomes of mucormycosis.

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