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Prognostic Factors for Survival Using a Clinical Severity Staging System Among Patients With Acute Invasive Fungal Sinusitis.
Munyemana, Marie-Ange; Kallogjeri, Dorina; Chernock, Rebecca; Farrell, Nyssa F; Schneider, John S; Piccirillo, Jay F; Roland, Lauren T.
Affiliation
  • Munyemana MA; Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
  • Kallogjeri D; Cooper Medical School of Rowan University, Camden, New Jersey.
  • Chernock R; Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
  • Farrell NF; Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
  • Schneider JS; Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery.
  • Piccirillo JF; Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri.
  • Roland LT; Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg ; 150(4): 328-334, 2024 Apr 01.
Article in En | MEDLINE | ID: mdl-38421674
ABSTRACT
Importance Despite the aggressive progression of fulminant acute invasive fungal sinusitis (AIFS), data on prognostic factors have been disparate, hindering the development of a staging system. A composite staging system may improve prognostication for patient counseling and conduct of clinical research.

Objective:

To identify prognostically important factors in AIFS and to incorporate the factors into a comprehensive Functional Severity Staging System and Clinical Severity Staging System. Design, Setting, and

Participants:

This retrospective cohort study included adult patients diagnosed with pathology-proven AIFS from June 1, 1992, to December 31, 2022, at Washington University Medical Center and Barnes-Jewish Hospital, a tertiary care center in St Louis, Missouri. Data were analyzed from April to July 2023. Main Outcome and

Measures:

Sequential sequestration and conjunctive consolidation was used to develop a composite staging system to predict 6-month overall survival.

Results:

Of 71 patients with pathology-proven AIFS over the 30-year period, the median (range) age of the cohort was 56 (19-63) years, and there were 47 (66%) male patients. The median (range) follow-up time was 2 (0-251) months. There were 28 patients alive within 6 months, for a 39% survival rate. Symptoms, comorbidity burden, and presence and duration of severe neutropenia were associated with 6-month survival and were consolidated into a 3-category Clinical Severity Staging System with 6-month survival of 75% for stage A (n = 16), 41% for stage B (n = 27), and 18% for stage C (n = 28). The discriminative power of the composite staging system was moderate (C statistic, 0.63). Conclusion and Relevance This cohort study supports the clinical importance of symptomatology, comorbidity burden, and prolonged severe neutropenia at the time of AIFS presentation. The composite clinical staging system may be useful for clinicians when counseling patients with AIFS and conducting clinical research.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sinusitis / Neutropenia Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: JAMA Otolaryngol Head Neck Surg Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sinusitis / Neutropenia Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: JAMA Otolaryngol Head Neck Surg Year: 2024 Document type: Article