Predictors of Mucormycosis in Hospitalized Patients with Postcoronavirus Disease 2019: A Role of Metabolic and Micronutrient Factors

BACKGROUND: During and after the coronavirus disease 2019 (COVID-19) surge, a notable increase in mucormycosis was observed, particularly among individuals with metabolic and treatment-related vulnerabilities. Emerging evidence suggests that micronutrient disturbances may also influence susceptibility. This study evaluated clinical predictors and micronutrient patterns associated with mucormycosis in post-COVID-19 patients. MATERIALS AND METHODS: A retrospective case-control study was conducted at a tertiary care center, including 139 post-COVID-19 patients who underwent testing for Vitamin B12, folate, and Vitamin D3. Patients were categorized into mucormycosis and nonmucormycosis groups based on microbiological or histopathological confirmation. Demographic, clinical, and biochemical variables were compared, and logistic regression identified independent predictors. RESULTS: Of 139 patients, 94 had mucormycosis. Diabetes mellitus (87.2% vs. 22.2%), steroid exposure (85.1% vs. 42.2%), and prolonged intensive care unit (ICU) stay (13.6 vs. 4.2 days) were significantly higher in mucormycosis patients (P < 0.001). Folate deficiency and Vitamin B12 deficiency were more common in the mucormycosis group, whereas Vitamin D deficiency was more frequent in nonmucormycosis patients. On multivariate analysis, independent predictors included diabetes mellitus (odds ratio [OR] = 28.94; P < 0.001), steroid exposure (OR = 4.82; P = 0.031), ICU stay (OR = 1.26/day; P = 0.004), Vitamin B12 deficiency (OR = 2.29; P = 0.046), and Vitamin D sufficiency (>40 ng/mL; OR = 2.52; P = 0.047). Preexisting pneumonia showed a strong inverse association (OR = 0.04; P = 0.002). CONCLUSION: Mucormycosis in post-COVID-19 patients is strongly associated with diabetes, corticosteroid exposure, and prolonged ICU care. Micronutrient disturbances, particularly Vitamin B12 and folate abnormalities, also appear relevant, while the paradoxical association of Vitamin D sufficiency warrants further investigation.