An internally validated diagnostic tool for acute invasive fungal sinusitis.
AIFS
acute invasive fungal sinusitis
diagnostic tool
immunocompromised
invasive fungal sinusitis
risk score
Journal
International forum of allergy & rhinology
ISSN: 2042-6984
Titre abrégé: Int Forum Allergy Rhinol
Pays: United States
ID NLM: 101550261
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
01
04
2020
revised:
29
04
2020
accepted:
30
05
2020
pubmed:
16
7
2020
medline:
30
9
2021
entrez:
16
7
2020
Statut:
ppublish
Résumé
Acute invasive fungal sinusitis (AIFS) is a potentially life-threatening diagnosis in immunocompromised patients. Identifying patients who could benefit from evaluation and intervention can be challenging for referring providers and otolaryngologists alike. We aimed to develop and validate an accessible diagnostic tool to estimate the probability of AIFS. Retrospective chart review from 1999 to 2017 identified all patients evaluated for possible AIFS at a tertiary care center. AIFS was diagnosed by pathologic confirmation of fungal tissue angioinvasion. Stepwise selection and univariate logistic regression were used to screen risk factors for a multivariable predictive model. Model performance was assessed using Tukey's goodness-of-fit test and the area under the receiver operator characteristic curve (AUC). Model coefficients were internally validated using bootstrapping with 1000 iterations. A total of 283 patients (244 negative controls, 39 with AIFS) were included. Risk factors in our final diagnostic model included: fever ≥38°C (log-odds ratio [LOR] 1.72; 95% CI, 0.53 to 2.90), unilateral facial swelling, pain, or erythema (LOR 2.84; 95% CI, 1.46 to 4.23), involvement of the orbit or pterygopalatine fossa on imaging (LOR 3.02; 95% CI, 1.78 to 4.26), and mucosal necrosis seen on endoscopy (LOR 5.52; 95% CI, 3.81 to 7.24), with p < 0.01 for all factors. The model had adequate goodness of fit (p > 0.05) and discrimination (AUC = 0.96). We present an internally validated diagnostic tool to stratify the risk for AIFS. The estimated risk may help determine which patients can be observed with serial nasal endoscopy, which ones could be biopsied, and which ones would benefit from immediate surgical intervention.
Sections du résumé
BACKGROUND
Acute invasive fungal sinusitis (AIFS) is a potentially life-threatening diagnosis in immunocompromised patients. Identifying patients who could benefit from evaluation and intervention can be challenging for referring providers and otolaryngologists alike. We aimed to develop and validate an accessible diagnostic tool to estimate the probability of AIFS.
METHODS
Retrospective chart review from 1999 to 2017 identified all patients evaluated for possible AIFS at a tertiary care center. AIFS was diagnosed by pathologic confirmation of fungal tissue angioinvasion. Stepwise selection and univariate logistic regression were used to screen risk factors for a multivariable predictive model. Model performance was assessed using Tukey's goodness-of-fit test and the area under the receiver operator characteristic curve (AUC). Model coefficients were internally validated using bootstrapping with 1000 iterations.
RESULTS
A total of 283 patients (244 negative controls, 39 with AIFS) were included. Risk factors in our final diagnostic model included: fever ≥38°C (log-odds ratio [LOR] 1.72; 95% CI, 0.53 to 2.90), unilateral facial swelling, pain, or erythema (LOR 2.84; 95% CI, 1.46 to 4.23), involvement of the orbit or pterygopalatine fossa on imaging (LOR 3.02; 95% CI, 1.78 to 4.26), and mucosal necrosis seen on endoscopy (LOR 5.52; 95% CI, 3.81 to 7.24), with p < 0.01 for all factors. The model had adequate goodness of fit (p > 0.05) and discrimination (AUC = 0.96).
CONCLUSION
We present an internally validated diagnostic tool to stratify the risk for AIFS. The estimated risk may help determine which patients can be observed with serial nasal endoscopy, which ones could be biopsied, and which ones would benefit from immediate surgical intervention.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
65-74Informations de copyright
© 2020 ARS-AAOA, LLC.
Références
Soler ZM, Schlosser RJ. The role of fungi in diseases of the nose and sinuses. Am J Rhinol Allergy. 2012;26:351-358.
Parikh SL, Venkatraman G, DelGaudio JM. Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 2004;18:75-81.
Monroe MM, McLean M, Sautter N, et al. Invasive fungal rhinosinusitis: a 15-year experience with 29 patients. Laryngoscope. 2013;123:1583-1587.
Epstein VA, Kern RC. Invasive fungal sinusitis and complications of rhinosinusitis. Otolaryngol Clin North Am. 2008;41:497-524, viii.
Turner JH, Soudry E, Nayak JV, Hwang PH. Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope. 2013;123:1112-1118.
DelGaudio JM, Clemson LA. An early detection protocol for invasive fungal sinusitis in neutropenic patients successfully reduces extent of disease at presentation and long term morbidity. Laryngoscope. 2009;119:180-183.
Fernandez IJ, Crocetta FM, Dematte M, et al. Acute invasive fungal rhinosinusitis in immunocompromised patients: role of an early diagnosis. Otolaryngol Head Neck Surg. 2018;159:386-393.
Silveira MLC, Anselmo-Lima WT, Faria FM, et al. Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients. BMC Infect Dis. 2019;19:310.
Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994;39:3-22.
Choi HS, Choi JY, Yoon JS, Kim SJ, Lee SY. Clinical characteristics and prognosis of orbital invasive aspergillosis. Ophthalmic Plast Reconstr Surg. 2008;24:454-459.
Roxbury CR, Smith DF, Higgins TS, et al. Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis. Am J Rhinol Allergy. 2017;31:109-116.
Melancon CC, Clinger JD. The use of frozen section in the early diagnosis of acute invasive fungal sinusitis. Otolaryngol Head Neck Surg. 2017;157:314-319.
Gillespie MB, O'Malley BW Jr, Francis HW. An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg. 1998;124:520-526.
Aribandi M, McCoy VA, Bazan C 3rd. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27:1283-1296.
Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA. Acute invasive fungal rhinosinusitis: a comprehensive update of CT findings and design of an effective diagnostic imaging model. AJNR Am J Neuroradiol. 2015;36:1529-1535.
Silverman CS, Mancuso AA. Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings. AJNR Am J Neuroradiol. 1998;19:321-325.
Mulvey CL, Rizzi MD, Buzi A. Predictive ability of bedside nasal endoscopy to diagnose invasive fungal sinusitis in a pediatric population. Int J Pediatr Otorhinolaryngol. 2018;115:82-88.
Payne SJ, Mitzner R, Kunchala S, Roland L, McGinn JD. Acute invasive fungal rhinosinusitis: a 15-year Experience with 41 patients. Otolaryngol Head Neck Surg. 2016;154:759-764.
Gillespie MB, Huchton DM, O'Malley BW. Role of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis. Laryngoscope. 2000;110:1832-1836.
Ghadiali MT, Deckard NA, Farooq U, Astor F, Robinson P, Casiano RR. Frozen-section biopsy analysis for acute invasive fungal rhinosinusitis. Otolaryngol Head Neck Surg. 2007;136:714-719.
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864-2870.
Williams LS, Rotich J, Qi R, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59:67-71.
Park MS, Kim DH, Kim DH, et al. Leukopenia predicts remission in patients with inflammatory bowel disease and Behcet's disease on thiopurine maintenance. Dig Dis Sci. 2015;60:195-204.
rms: Regression Modeling Strategies [computer program]. Version 5.1-4. Nashville, TN: R Foundation; 2019.
Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD. Prognostic modelling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med. 2000;19:1059-1079.
Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21:128-138.
Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5:1315-1316.
Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54:774-781.
Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2011;137:1005-1010.
Jung SH, Kim SW, Park CS, et al. Rhinocerebral mucormycosis: consideration of prognostic factors and treatment modality. Auris Nasus Larynx. 2009;36:274-279.
Finkelstein A, Contreras D, Pardo J, et al. Paranasal sinuses computed tomography in the initial evaluation of patients with suspected invasive fungal rhinosinusitis. Eur Arch Otorhinolaryngol. 2011;268:1157-1162.
DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA. Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2003;129:236-240.
Gamba JL, Woodruff WW, Djang WT, Yeates AE. Craniofacial mucormycosis: assessment with CT. Radiology. 1986;160:207-212.
Motomura C, Odajima H, Yamada A, Taba N, Murakami Y, Nishima S. Pale nasal mucosa affects airflow limitations in upper and lower airways in asthmatic children. Asia Pac Allergy. 2016;6:220-225.
Drakos PE, Nagler A, Or R, et al. Invasive fungal sinusitis in patients undergoing bone marrow transplantation. Bone Marrow Transplant. 1993;12:203-208.
Wandell GM, Miller C, Rathor A, et al. A multi-institutional review of outcomes in biopsy-proven acute invasive fungal sinusitis. Int Forum Allergy Rhinol. 2018;8:1459-1468.
Mignogna MD, Fortuna G, Leuci S, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis. 2011;15:e533-e540.