Data_Sheet_1_The outcome and the risk factors of mucormycosis among patients with hematological diseases: a systematic and meta-analysis.docx

ObjectivesMucorale has come into a significant pathogen over recent decades. Nonetheless, mucormycosis-related mortality rates among patients with hematological disorders remain unascertained. Thus, we conducted a meta-analysis to determine mortality rates of mucormycosis in patients with hematology-related conditions.
MethodsWe scoured PubMed, Embase, and Web of Science for original papers exploring the intersection of Mucormycosis and Hematological Diseases (from 2000 to 2022). We scrutinized the overall mortality across three distinct periods, as well as differentiating between high-income and middle-income nations. We further evaluated the pooled mortality and the risk differential (RD) across several subgroups.
ResultsThe overall mortality rate for hematology patients with mucormycosis was 61%, within a 95% confidence interval (CI) of 0.54–0.68. A significant observation was that mortality rates were somewhat lower in high-income countries compared to middle-income countries (0.60 versus 0.64, p = 0.45). Importantly, we discovered that a combination of surgical and medical treatment significantly improved survival rates compared to medical treatment alone [mortality 0.49 versus 0.67, RD -0.19 (95%CI -0.38-0.00, I2 63.7%)]. As might be expected, disseminated mucormycosis posed a significantly higher risk of death compared to isolated mucormycosis [0.60 versus 0.57, RD death 0.16 (95%CI 0.03–0.28)]. Additionally, our analysis showed no discernible differences in survival rates between genders, between patients with and without breakthrough infection, between those who received mucor-active or mucor-inactive drugs prior to mucor infection, or between those on a multi-drug regimen and those on a single drug treatment.
ConclusionDespite the high mortality rates associated with mucormycosis in patients with hematological disorders, those receiving both medical and surgical interventions, as well as those with isolated infection sites, exhibited improved survival outcomes. Conversely, factors such as gender, the presence of breakthrough infection, the use of mucor-active drugs before mucor infection, and multi-drug administration did not significantly influence patient outcomes.

研究目的：近数十年来，毛霉目（Mucorale）已成为一类重要的致病真菌。然而，血液系统疾病患者合并毛霉病的相关病死率仍未明确。为此，本研究开展一项荟萃分析，以明确血液系统疾病患者感染毛霉病后的病死率。
研究方法：我们检索了PubMed、Embase及Web of Science数据库，筛选2000年至2022年间探讨毛霉病与血液系统疾病相关性的原创性研究。我们分析了三个不同时间段的总体病死率，并区分了高收入国家与中等收入国家的亚组数据。此外，我们还评估了合并病死率及多个亚组间的风险差（RD）。
研究结果：血液系统疾病合并毛霉病患者的总体病死率为61%，95%置信区间（CI）为0.54~0.68。值得注意的是，高收入国家的病死率略低于中等收入国家（0.60 vs 0.64，p=0.45）。关键发现为，与单纯内科治疗相比，联合外科与内科治疗可显著改善患者生存率（病死率分别为0.49与0.67，风险差RD=-0.19，95%CI：-0.38~0.00，I²=63.7%）。正如预期，播散性毛霉病患者的死亡风险显著高于孤立性毛霉病患者（0.60 vs 0.57，死亡风险差RD=0.16，95%CI：0.03~0.28）。此外，本分析未发现以下因素对生存率存在显著影响：性别、是否存在突破感染、毛霉感染前是否使用抗毛霉活性药物或抗毛霉无活性药物，以及采用多药联合治疗方案还是单药治疗。
研究结论：尽管血液系统疾病患者合并毛霉病的病死率较高，但接受内外联合治疗以及感染部位局限的患者，其生存结局更佳。反之，性别、是否存在突破感染、毛霉感染前使用抗毛霉活性药物或抗毛霉无活性药物，以及多药给药方案，均未对患者预后产生显著影响。