Risk factors for mortality in patients with mucormycosis.
Author(s): Spellberg B, Kontoyiannis DP, Fredricks D, Morris MI, Perfect JR, Chin-Hong PV,
Ibrahim AS, Brass EP.
Affiliation(s): Division of General Internal Medicine, Los Angeles Biomedical Research Institute,
Harbor-University of California Los Angeles (UCLA) Medical Center, Los Angeles,
CA, USA. bspellberg@labiomed.org
Publication date & source: 2012, Med Mycol. , 50(6):611-8
Optimal clinical care and clinical investigation of patients with mucormycosis
are limited by absence of controlled trials, and absence of well-defined
predictors of mortality or clinical response. The Deferasirox-AmBisome Therapy
for mucormycosis (DEFEAT Mucor) study was the first randomized clinical trial
conducted on patients with mucormycosis, and demonstrated that adjunctive
deferasirox therapy did not improve outcomes of the disease. The current study
describes clinical factors from the 20 patients enrolled to identify those
associated with 90-day mortality of the 11 (55%) patients who died by day 90.
Age, diabetes mellitus, transplant status, or antifungal therapy were not
associated with mortality. However, active malignancy or neutropenia at
enrollment were associated with increased mortality. Pulmonary infection was
linked with lower Kaplan-Meier survival compared to non-pulmonary infection.
Higher baseline serum concentrations of iron and ferritin were also associated
with mortality. No patient who progressed clinically during the first 14 days of
study therapy survived; however, many patients who clinically improved during
that time did not survive to 90 days. In contrast, day 30 clinical response was
predictive of 90-day survival. These factors may be useful in defining enrollment
randomization stratification critieria for future clinical trials, and in
supporting clinical care of patients with mucormycosis.
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