Serum iron indices in COVID‐19‐associated mucormycosis: A case–control study

Abstract

Background: Whether dysregulated iron metabolism is associated with COVID-19associated mucormycosis (CAM) remains unknown. Herein, we compare the serum iron indices in COVID-19 subjects with and without mucormycosis. Methods: We conducted a case-control study enrolling COVID-19 participants with and without mucormycosis. We compared the baseline serum iron indices (iron, ferritin, total iron-binding capacity [TIBC], unsaturated iron-binding capacity and percentage transferrin saturation) between CAM cases and COVID-19 controls. Additionally, we performed a multivariate logistic regression analysis to assess whether any iron indices are associated with CAM.Results: We enrolled 28 CAM cases (mean age 53.6 years old; 78.6% men) and 26 controls (mean age 57.2 years old; 73.1% men). Rhino-orbital (±cerebral) mucormycosis (85.7%) was the most clinical presentation. Diabetes mellitus was more frequent in the cases than controls (75% vs. 42.3%; p = .015). Hypoxaemia during COVID-19 illness was more common in controls than cases. The mean serum iron values (33 vs. 45 μg/dl, p = .03) and TIBC (166.6 vs. 201.6 μg/dl, p = .003) were significantly lower in CAM cases than controls. On multivariate analysis, we found a lower TIBC (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.95-0.99) and diabetes mellitus (OR 5.23; 95% CI,) to be independently associated with CAM after adjusting for serum iron, ferritin and glucocorticoid therapy. The case fatality rate of CAM was 73.9%. The iron indices were not significantly different between CAM survivors and non-survivors. Conclusions:The CAM is associated with lower TIBC levels than COVID-19 subjects without mucormycosis, suggesting dysregulated iron metabolism in its pathogenesis.Further studies are required to confirm our preliminary observations.

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

“… 25 , 26 COVID-19 per se, and the associated dysregulation of iron metabolism, were also considered to be contributing factors. 27 Although patients with COVID-19 requiring intensive care have been noted to develop CAPM, 13 , 16 most experts believed that intensive care was not an independent risk factor. The CAPM-GG did not consider zinc supplementation, contaminated humidifiers, industrial oxygen, or reused masks as risk factors for CAPM.…”

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 47 ] India Retrospective Single-center 11 Feb 2020–May 2021 47 ± 11 100 (11) 64 (7) Fouad YA. [ 48 ] Egypt Retrospective Single-center 26 Apr 2021–Aug 2021 63 [46–70] 54 (14) 96 (25) Meher R. [ 49 ] Iran Prospective Single-center 111 May 2021–Jun 2021 53 ± 12 70 (78) 94 (104) Guzman-Castro S. [ 50 ] UK Retrospective Single-center 6 May 2021 52 [45–57] 83 (5) 83 (5) Kumar H. [ 51 ] India Retrospective Single-center 28 Apr 2021–May 2021 54 [48–59] 79 (22) 75 (21) Yadav T. [ 52 ] India Retrospective Single-center 50 Dec 2020–Jun 2021 50 [28–70] 62 (31) 86 (43) Meshram HS. [ 53 ] India Retrospective …”

“…[ 47 ] 45 (5) 100 (11) 100 (11) – 36 (4) 0 (0) 36 (4) – Fouad YA. [ 48 ] 27 (7) 12 (3) – – – – 77 (20) – Meher R. [ 49 ] – – – – 27 (30) 5.4 (6) 60 (67) 5.4 (6) Guzman-Castro S. [ 50 ] – – – – 50 (3) 33 (2) 100 (6) – Kumar H. [ 51 ] – – – – 57 (16) 21 (6) 68 (19) – Yadav T. [ 52 ] – – 2.0 (1) – 38 (19) – 44 (22) – Meshram HS. [ 53 ] – 100 (61) 100 (61) – 67 (41) 0 (0) …”

Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

“…PM accounts for only about 10–20% of the total mucormycosis (and < 10% among COVID-19-associated mucormycosis) but carries a high mortality. [ 17 – 20 ] PM is difficult to diagnose, primarily due to the non-specific imaging findings [ 21 ] and lack of awareness. [ 22 , 23 ] Massive hemoptysis can be seen in as high as one-third of PM [ 24 ] and is an independent predictor of survival.…”