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Predictive factors for invasive fungal rhinosinusitis in diabetic patients: Systematic review and data re-analysis
Thwe Phyo Kan Nyunt1,2, Joaquim Mullol3, Kornkiat Snidvongs1,2
1Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
This systematic review aims to identify prognostic factors for the overall survival of invasive fungal rhinosinusitis (IFRS) in patients with diabetes using original data from the existing published articles. Systematic searches of Medline, EMBASE, and Cochrane Library databases were performed to include articles from 1988 to 2019 using the terms: "fung*" AND "rhinosinusitis" AND "invasive" AND "diabetes OR ketoacidosis". Data from 258 diabetic patients with IFRS (mean age 55.9 years, 55.6% male, 124 studies) were extracted for data analysis. The mortality rate was 31.8%. Seven variables: plasma glucose level, HbA1C, ketoacidosis, leukopenia, serum creatinine level, duration of diabetes, and the cavernous sinus extension were assessed. Univariate analysis was done for each variable and revealed that the cavernous sinus extension was a significant risk factor. Multivariable logistic regression analysis confirmed that the cavernous sinus extension independently predicted mortality in patients with diabetes (hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.2 to 5.4, p = 0.01). Kaplan Meier curve and Log-rank test were used for analyzing survival outcomes. The twelve-month overall survival rate of the patients with the cavernous sinus extension was 43.9% compared to 73.9% for the patients without the cavernous sinus extension (p = 0.01). Appropriate treatment of this condition could enhance the survival outcomes.
Insights
Invasive fungal rhinosinusitis (IFRS) in diabetic patients has a high mortality rate. Cavernous sinus extension is a significant risk factor for poor survival in these patients.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Endocrinology
Background:
- Invasive fungal rhinosinusitis (IFRS) poses a significant threat to patients with diabetes.
- Identifying prognostic factors is crucial for improving survival outcomes in diabetic IFRS patients.
Purpose of the Study:
- To systematically review and identify prognostic factors for overall survival in invasive fungal rhinosinusitis (IFRS) among patients with diabetes.
- To analyze original data from published articles to determine key predictors of mortality.
Main Methods:
- Systematic literature searches were conducted in Medline, EMBASE, and Cochrane Library databases (1988-2019).
- Data from 258 diabetic patients with IFRS were extracted and analyzed.
- Univariate and multivariable logistic regression analyses were performed, along with Kaplan-Meier survival analysis.
Main Results:
- The overall mortality rate for IFRS in diabetic patients was 31.8%.
- Cavernous sinus extension was identified as a significant risk factor for mortality (HR 2.6, p=0.01).
- Twelve-month survival was significantly lower in patients with cavernous sinus extension (43.9%) compared to those without (73.9%, p=0.01).
Conclusions:
- Cavernous sinus extension independently predicts mortality in diabetic patients with IFRS.
- Early detection and appropriate management of IFRS, particularly with cavernous sinus involvement, can improve patient survival.
- Further research into specific treatment strategies for IFRS with cavernous sinus extension is warranted.
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