COVID-19-Associated Mucormycosis: Identifying Mortality Predictors in a Retrospective Cohort Study.

Background: COVID-19-associated mucormycosis (CAM) has emerged as a serious complication of COVID-19, exacerbated by the use of immunosuppressive treatments. This study aims to assess the clinical outcomes and identify predictors of mortality in adult patients with CAM. Methods: This retrospective cohort study was conducted at a major referral center in Mashhad, Iran, from the start of the COVID-19 pandemic until the end of its fifth wave in Iran. Results: Of the 81 patients studied, 55.6% were male, with a median age of 60.0 years. Diabetes mellitus was the most common comorbidity, present in 76.5% of patients. Corticosteroids were used in 90.1% of cases. One-month survival was 61.7%, decreasing to 51.9% at three months and stabilizing at 50.6% at six and twelve months. CRP levels were associated with increased mortality (P-value = .001), while longer antifungal treatment duration was linked to reduced mortality (P-value < .001). Moreover, palatal necrosis (HR: 2.12) and the use of posaconazole (HR: 0.16) were significantly associated with the risk of mortality. While the former was a risk factor, the latter reduced the mortality rate. Conclusions: Our study contributes to the growing body of evidence on the clinical and epidemiological characteristics of CAM, highlighting the need for early diagnosis, risk factor identification, and prompt, prolonged treatment to enhance patient outcomes. Elevated CRP was identified as a predictor of mortality in CAM. Future research should aim to refine risk stratification methods and optimize therapeutic protocols to address the high mortality rates associated with this severe condition.