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Published on: March 22, 2012
Risk Stratification of Acute Invasive Fungal Rhinosinusitis in Patients With Hematologic Pathology
Sriram Navuluri1, James Reed Gardner1, Donald Vickers1
1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Objective:
The purpose of this study is to identify objective perioperative diagnostic factors for acute invasive fungal rhinosinusitis (AIFS) to create a diagnostic scoring system using objective criteria.
Methods:
Retrospective case-control study performed at an academic, tertiary care center. Biopsy-proven cases of AIFS identified from pathology records (2015-2019) were compared to patients the otolaryngology service was consulted to "Rule out AIFS" in the year 2019, only including those with underlying hematologic malignancy. Eighteen patients with AIFS and 20 patients without were included. One and two tailed T-tests were used for p-values. Receiver operating characteristic curves were generated for the significant data, and Youden's J-statistic was used to create the ideal cutoff values for each. Likelihood ratios were used to give a power for the scoring system.
Results:
Compared to patients with non-hematologic malignancy-related AIFS, patients with hematologic malignancy-related AIFS have significantly elevated C-reactive protein (CRP) and blood glucose; while albumin, hematocrit, platelet count, and absolute neutrophil count (ANC) were found to be significantly lower. In addition, Lund-Mackay score asymmetry, extra-sinus spread, aspergillus antigen, and pre-existing diabetes mellitus correlated with disease. A scoring system with three categories: AIFS Unlikely, Indeterminate/AIFS Suspicious, and AIFS Highly Likely was developed.
Conclusion:
Patients with hematologic malignancy-related AIFS have measurable differences in lab values and standard imaging that could be used in determining the diagnostic probability of AIFS including: CRP, albumin, hematocrit, platelets, ANC, blood glucose, aspergillus antigen, Lund-Mackay score asymmetry, extra-sinus spread, and pre-existing diabetes mellitus. A novel scoring system was proposed that will require prospective validation.
Level Of Evidence:
3 Laryngoscope, 133:1059-1064, 2023.
Insights
This study identifies objective factors for diagnosing acute invasive fungal rhinosinusitis (AIFS) in patients with hematologic malignancy. A novel scoring system using lab values and imaging is proposed to aid diagnosis.
Area of Science:
- Otolaryngology
- Infectious Disease
- Hematology
Background:
- Acute invasive fungal rhinosinusitis (AIFS) poses diagnostic challenges, particularly in immunocompromised patients.
- Objective perioperative factors are needed to improve AIFS diagnosis.
Purpose of the Study:
- To identify objective perioperative diagnostic factors for AIFS.
- To develop a diagnostic scoring system for AIFS using objective criteria.
Main Methods:
- Retrospective case-control study comparing AIFS cases with controls.
- Analysis included laboratory values (CRP, glucose, albumin, hematocrit, platelets, ANC) and imaging findings (Lund-Mackay score, extra-sinus spread).
- Receiver operating characteristic curves and Youden's J-statistic were used to develop a scoring system.
Main Results:
- Patients with hematologic malignancy-related AIFS showed elevated CRP and blood glucose, and lower albumin, hematocrit, platelets, and ANC compared to controls.
- Factors correlating with AIFS included Lund-Mackay score asymmetry, extra-sinus spread, aspergillus antigen, and diabetes mellitus.
- A three-category scoring system (Unlikely, Indeterminate/Suspicious, Highly Likely) was developed.
Conclusions:
- Measurable differences in lab values and imaging exist between AIFS patients with hematologic malignancy and controls.
- Objective factors like CRP, ANC, aspergillus antigen, and imaging findings can aid AIFS diagnosis.
- A novel scoring system requires prospective validation.
