# P-1109. Steroid Duration and Mucormycosis Severity in COVID-19: A Dose-Response Relationship

## TL;DR

This study shows that longer corticosteroid use in COVID-19 patients increases the risk of severe mucormycosis, especially intracranial cases.

## Contribution

The study establishes a dose-response relationship between steroid duration and mucormycosis severity in COVID-19 patients.

## Key findings

- Patients on steroids for more than 10 days had a 4x higher risk of intracranial mucormycosis.
- Each additional day of steroid use increased mucormycosis risk by 12%.
- Prolonged steroid use led to more surgeries and complicated hospitalizations, particularly in diabetic patients.

## Abstract

The COVID-19 pandemic saw a worrisome rise in mucormycosis cases in India, especially among those receiving corticosteroid therapy. While corticosteroids are essential for managing severe COVID-19 cases, their immunosuppressive action appears to augment infection risk. Clinically, prolonged steroid use may result in severe forms of mucormycosis; however, this requires rigorous systematic evaluation.

We conducted an exhaustive analysis of 327 mucormycosis cases and 596 COVID-19 controls, all of whom were treated during the second wave in India. Exposure to steroids was carefully categorized by duration into three groups: short-term (1-5 days), standard-term (5-10 days), and long-term ( > 10 days). Each case was biopsy-proven, with further radiographic confirmation of disease extent. Special emphasis was laid on intracranial extension as a marker of severity, along with tracking treatment outcomes and survival. Statistical modeling was used to correct for important confounders, including diabetes status, glycemic control, and concurrent use of other immunomodulators.

The results were striking. Those receiving steroid treatment for more than ten days of duration had a nearly fourfold higher incidence of intracranial mucormycosis compared with short-term-treated patients (38.2% vs. 12.5%, p< 0.001). Each day of steroid use accounted for a 12% increase in associated risk. While mortality rates were equal, patients receiving prolonged treatment had a considerably increased number of surgical procedures (35.3% vs. 16.7%, p=0.02) as well as more complicated hospitalization. Those with diabetes were especially sensitive to such effects of prolonged treatment.

The study highlights the role of cautious use of corticosteroids in the management of COVID-19. Our work gives strong evidence for the importance of compliance with guideline-based recommendations for corticosteroid duration, especially for high-risk populations. This study empowers healthcare practitioners with unequivocal evidence to provide optimal COVID-19 treatments while avoiding the risk of severe fungal infection.

All Authors: No reported disclosures