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Acute invasive fungal rhinosinusitis: Survival analysis and the prognostic indicators
Sercan Gode1, Goksel Turhal, Kerem Ozturk
1Otolaryngology Department, Ege University Medical School, Izmir, Turkey.
Background:
Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of the paranasal sinuses and surrounding structures that is almost always seen in patients who are immunocompromised. Despite the use of newer antifungal treatments and early diagnosis, the prognosis of AIFR does not improve significantly. Due to the higher incidence of patients who are immunocompromised and have more complex disease, AIFR is a growing medical issue in tertiary medical centers.
Objective:
The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery.
Methods:
Between October 2009 and November 2014, 37 patients who underwent surgery for AIFR at a tertiary care university hospital were included in the study. Overall survival and disease-specific mortality and survival rates were calculated to estimate survival function. The impact of age, sex, underlying disease, extent of AIFR, applied medical treatment, and causative species (mucormycosis, aspergillosis) were also taken into consideration. Also, the effect of a variety of laboratory parameters, such as hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, and C-reactive protein (CRP) levels, to survival were evaluated.
Results:
The median follow-up time was 58 days (interquartile range = 304). Overall and disease-specific mortality rates were 64.9 and 51.4%, respectively. Fever was the most common symptom (86.5%), along with nasal obstruction and/or fullness (48.6%) and epistaxis (48.6%). Age and sex did not have a significant impact on survival (p > 0.05). Palate involvement was significantly associated with mortality (p < 0.05). According to the results of Cox, regression analysis for disease-specific mortality rate, leukocyte and neutrophil counts as well as CRP levels had a significant effect on survival function (p < 0.05).
Conclusions:
Palatal involvement was associated with a higher mortality in our study. Also, leukocyte counts, neutrophile counts, and CRP values had a significant impact on survival function. The reversal of the underlying disease and immunosuppression is as important as the medical and surgical treatment.
Insights
Acute invasive fungal rhinosinusitis (AIFR) is a serious condition with high mortality. Palatal involvement and elevated leukocyte/neutrophil counts with high CRP levels indicate a poorer prognosis for AIFR patients.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Surgical Oncology
Background:
- Acute invasive fungal rhinosinusitis (AIFR) is a life-threatening fungal infection primarily affecting immunocompromised individuals.
- Despite advancements, AIFR prognosis remains poor, posing a growing challenge in tertiary care settings.
- This study focuses on surgical outcomes and prognostic factors in AIFR patients.
Purpose of the Study:
- To present surgical outcomes for AIFR patients.
- To identify key prognostic indicators influencing survival in AIFR.
- To analyze the impact of clinical and laboratory parameters on AIFR patient survival.
Main Methods:
- Retrospective analysis of 37 AIFR patients undergoing surgery (Oct 2009 - Nov 2014).
- Evaluation of overall and disease-specific survival rates.
- Assessment of factors including age, sex, underlying disease, AIFR extent, treatment, causative fungal species, and laboratory markers (leukocytes, neutrophils, CRP).
Main Results:
- Overall and disease-specific mortality rates were 64.9% and 51.4%, respectively.
- Palatal involvement was significantly associated with increased mortality (p < 0.05).
- Elevated leukocyte and neutrophil counts, along with C-reactive protein (CRP) levels, significantly impacted survival (p < 0.05).
Conclusions:
- Palatal involvement is a critical predictor of mortality in AIFR.
- Leukocyte count, neutrophil count, and CRP levels are significant prognostic markers for AIFR survival.
- Addressing underlying immunosuppression is crucial alongside medical and surgical interventions.
