Survival and quality-of-life in mucormycosis: a multicentric ambispective cohort study

Objectives: We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalized with mucormycosis. Methods: This prospective, multicentre cohort study included patients hospitalized for mucormycosis across 26 sites in India from March to July 2021. Follow-up data were collected at 1-, 3-, 6-, and 12-month intervals post-discharge through telephonic or in-person interviews with patients or caregivers. Primary outcomes were survival, sequelae, and quality of life, assessed using the EURO-QOL 5D-5L scale. Survival analyses were performed using the shared frailty Cox proportional hazards model for predefined subgroups. Additional sensitivity analyses using inverse probability of censoring weights and marginal structural modelling were conducted to account for loss to follow-up and the time-varying nature of the treatment and confounders. Results: Of the 686 patients, 101 deaths (14.7%) occurred within 1 year, with a median survival time of 230 days. The majority of deaths (64.3%) occurred early, i.e. during hospitalization. Independent predictors of mortality included orbit involvement (hazard ratio [HR]: 2.0, 95% CI: 1.2–3.4), intracranial/cerebral involvement (HR: 2.6, 95% CI: 1.5–4.4), admission to an intensive care unit (HR: 6.4, 95% CI: 3.5–11.6), poor glycaemic control (HR: 2.3, 95% CI: 1.1–4.7), and other comorbidities (HR: 1.6, 95% CI: 1.0–2.5), and those associated with lower mortality were combination antifungal therapy (HR: 0.2, 95% CI: 0.1–0.4) and receipt of surgical treatment (HR: 0.1, 95% CI: 0.07–0.2). Survivors demonstrated improved quality of life, especially those who were gainfully employed. Sensitivity analysis indicated no major impact of loss to follow-up on survival. Discussion: Poor glycaemic control, severe disease, and involvement of the orbit or intracranial/cerebral regions predict higher mortality in mucormycosis. Aggressive therapeutic strategies, including combination of antifungal therapy and surgical interventions, substantially improved survival. The study highlights the importance of integrating psychological rehabilitation and socioeconomic support into management protocols to enhance the quality of life among survivors.