Clinical factors associated with acute exacerbations of chronic rhinosinusitis - 08/06/20
Abstract |
Background |
Chronic rhinosinusitis (CRS) is complicated by frequent acute exacerbations leading to significant health care burden and impaired quality of life.
Objective |
The objective of this study was to identify clinical factors associated with frequent acute exacerbation of CRS (AECRS).
Methods |
This is a retrospective cohort study of patients with CRS from January 1, 2014, to May 31, 2016. Frequent AECRS was defined as at least 4 episodes over a 12-month period in which an antibiotic was prescribed for worsening sinus symptoms, and infrequent AECRS was defined as 0 to 3 episodes. Clinical factors, including asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease, were evaluated for associations between the 2 groups.
Results |
Of the 3109 patients with CRS who were identified, 600 (19.3%) were classified as having frequent exacerbation. Asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease were associated with frequent AECRS with statistically significant adjusted odds ratios (aORs) after controlling for age, race, and sex in multivariate analysis (asthma aOR = 2.61 [95% CI = 2.14-3.18]; allergic rhinitis aOR = 1.96 [95% CI = 1.58-2.42]; eosinophil count of at least 150 cells per microliter aOR = 1.54 [95% CI = 1.21-1.97]; and autoimmune disease aOR = 1.68 [95% CI = 1.36-2.07]). Antibody deficiency, antibiotic allergy, lower FEV1, radiographic sinus disease severity, nasal polyposis, and systemic corticosteroid use were also associated with frequent AECRS.
Conclusion |
Patients with frequent episodes of AECRS were characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, autoimmune disease, and other allergic and immunologic diseases. These findings identify a high-risk phenotype of patients with CRS for preventive interventions to reduce exacerbation frequency.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Chronic rhinosinusitis, exacerbation, antibiotics, asthma, allergic rhinitis, eosinophils, autoimmune disease
Abbreviations used : AECRS, BMI, CRS, CRSwNP, CT, EMR, ICD-9, QOL
Plan
| Supported by the Chronic Rhinosinusitis Integrated Studies Program (grant U19 AI106683-01); the Chronic Rhinosinusitis Integrated Studies Program 2 (grant P01AI145818); the Ernest Bazley Foundation; the National Institutes of Health National Center for Advancing Translational Sciences (grant UL1TR001422); and the Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine. |
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| Disclosure of potential conflict of interest: A. T. Peters has served as an advisor to Sanofi, AstraZeneca, Novartis, and Optinose. R. P. Schleimer reports grants from NIH during conduct of the study and has received personal fees for serving as a consultant to Intersect ENT, GlaxoSmithKline, Allakos, Aurasense, Merck, BioMarck, Sanofi, AstraZeneca/Medimmune, Genentech, Exicure Inc, Otsuka Inc, Aqualung Therapeutics Corp, and ActoBio Therapeutics outside the submitted work. In addition, R. P. Schleimer has Siglec-8– and Siglec-8 ligand–related patents licensed to Allakos Inc. S. S. Smith reports research supported in part by the Northwestern University Patient-centered Intervention and Engagement Training K12 Faculty Scholars Training Program (K12HS023011). W. W. Stevens has served as an advisor to GlaxoSmithKline. The rest of the authors declare they have no relevant conflict of interests. |
Vol 145 - N° 6
P. 1598-1605 - juin 2020 Retour au numéro
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