Clinical characteristics and risk factors for mortality in pulmonary mucormycosis among patients with non-hematologic malignancies
- 1Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Beijing, Chaoyang District, 100020 China
- 2Beijing Key Laboratory of Multimodal Intelligent Diagnosis and Treatment System for Respiratory Diseases, Beijing, China
Abstract
Background: Pulmonary mucormycosis (PM) is a life-threatening fungal infection typically reported in neutropenic patients with hematologic malignancies (HM), but its features in non-hematologic malignancy (NHM) patients remain unclear. This study aimed to characterize the clinical presentation, treatment, and outcomes of PM in NHM patients.
Methods: This retrospective study (March 1, 2017-July 31, 2024) at Beijing Chaoyang Hospital included 46 NHM-PM patients, predominantly diabetes mellitus (DM) and solid organ transplantation (SOT). The primary outcome was 90-day all-cause mortality. Survival was analyzed using Kaplan-Meier curves and Cox regression, with adjustment for age, sex, and diabetes mellitus. The proportional hazards assumption was verified (GLOBAL p = 0.515).
Results: Among 46 PM patients with NHM, DM was present in 71.7%. The 90-day mortality rate was 37.0% (17/46). Non-survivors had higher rates of respiratory failure, intensive care unit (ICU) admission, and septic shock, along with lower hemoglobin and higher D-dimer and procalcitonin (all P < 0.05). Univariable Cox regression identified solid organ transplantation (HR = 6.97), the use of immunosuppressants (HR = 5.58), elevated D-dimers, and elevated procalcitonin as significant mortality predictors (all P < 0.01), whereas longer hospital stay and longer time to treatment initiation were protective (both P < 0.05). Multivariable Cox regression confirmed the use of immunosuppressants as an independent risk factor (adjusted HR = 7.51, 95% CI: 2.72–20.74, P < 0.001). Kaplan-Meier curves showed significantly worse survival for the use of immunosuppressants and SOT recipients (log-rank P < 0.001 for both).
Conclusions: The use of immunosuppressants and SOT are both important factors associated with 90-day mortality in NHM-PM patients. These findings highlight the poor prognosis associated with immunosuppression and support early, aggressive intervention in this high-risk population. Validation in larger cohorts is warranted.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12890-026-04474-x.
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BibTeX
@article{zhang2026clinical,
title = {{Clinical characteristics and risk factors for mortality in pulmonary mucormycosis among patients with non-hematologic malignancies}},
author = {Renwen Zhang and Yongzhe Liu and Ran Li and Li Gu},
journal = {BMC Pulmonary Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12890-026-04474-x},
url = {https://doi.org/10.1186/s12890-026-04474-x},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical characteristics and risk factors for mortality in pulmonary mucormycosis among patients with non-hematologic malignancies
AU - Renwen Zhang
AU - Yongzhe Liu
AU - Ran Li
AU - Li Gu
PY - 2026
DA - 2026/07/08
JO - BMC Pulmonary Medicine
DO - 10.1186/s12890-026-04474-x
UR - https://doi.org/10.1186/s12890-026-04474-x
AB - Background: Pulmonary mucormycosis (PM) is a life-threatening fungal infection typically reported in neutropenic patients with hematologic malignancies (HM), but its features in non-hematologic malignancy (NHM) patients remain unclear. This study aimed to characterize the clinical presentation, treatment, and outcomes of PM in NHM patients. Methods: This retrospective study (March 1, 2017-July 31, 2024) at Beijing Chaoyang Hospital included 46 NHM-PM patients, predominantly diabetes mellitus (DM) and solid organ transplantation (SOT). The primary outcome was 90-day all-cause mortality. Survival was analyzed using Kaplan-Meier curves and Cox regression, with adjustment for age, sex, and diabetes mellitus. The proportional hazards assumption was verified (GLOBAL p = 0.515). Results: Among 46 PM patients with NHM, DM was present in 71.7%. The 90-day mortality rate was 37.0% (17/46). Non-survivors had higher rates of respiratory failure, intensive care unit (ICU) admission, and septic shock, along with lower hemoglobin and higher D-dimer and procalcitonin (all P < 0.05). Univariable Cox regression identified solid organ transplantation (HR = 6.97), the use of immunosuppressants (HR = 5.58), elevated D-dimers, and elevated procalcitonin as significant mortality predictors (all P < 0.01), whereas longer hospital stay and longer time to treatment initiation were protective (both P < 0.05). Multivariable Cox regression confirmed the use of immunosuppressants as an independent risk factor (adjusted HR = 7.51, 95% CI: 2.72–20.74, P < 0.001). Kaplan-Meier curves showed significantly worse survival for the use of immunosuppressants and SOT recipients (log-rank P < 0.001 for both). Conclusions: The use of immunosuppressants and SOT are both important factors associated with 90-day mortality in NHM-PM patients. These findings highlight the poor prognosis associated with immunosuppression and support early, aggressive intervention in this high-risk population. Validation in larger cohorts is warranted. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12890-026-04474-x.
SN - 1471-2466
ER -