A multi‐institutional review of outcomes in biopsy‐proven chronic invasive fungal sinusitis. Issue 6 (13th April 2020)

• Record Type: Journal Article
• Authors: Humphreys, Ian M.; Wandell, Grace M.; Miller, Craig; Rathor, Aakanksha; Schmidt, Rodney A.; Turner, Justin H.; Hwang, Peter H.; Davis, Greg E.
• Is Part Of: International forum of allergy & rhinology. Volume 10:Issue 6(2020:Jun.)
• Page Start: 738
• Page End: 747
• Publication Date: 2020-04-13
• Subjects: invasive fungal sinusitis -- paranasal sinus disease -- fungal sinusitis -- sinusitis -- chronic disease; 617.51005
• DOI: 10.1002/alr.22547
• Languages: English
• ISSNs: 2042-6976

Abstract

Abstract : Background: Chronic invasive fungal sinusitis (CIFS) is a rare, life‐threatening infection of the nose and sinuses. This study aims to identify factors that impact survival in 1 of the largest cohorts to date. Methods: Pathology records were reviewed for biopsy‐proven CIFS from 3 tertiary academic institutions from 1995 to 2016. Variables were analyzed using log‐rank survival analysis. Univariate Cox regression was performed at 1 and 12 months. Results: Thirty‐eight patients were included. Hematologic malignancy and diabetes were the most common underlying diseases (32% each). Aspergillus was the most common fungus (63%). Greater than 75% of the patients had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. Overall survival at 1, 6, and 12 months was 89%, 68%, and 48%, respectively. In univariate analysis, factors associated with worse survival included: ANC <500 at 12 months (hazard ratio [HR] 4.8; p = 0.01), ANC <1000 at 12 months (HR 5.8; p = 0.001), and recent chemotherapy (HR 4; p = 0.01). The following factor was associated with improved survival in univariate analysis: ANC as a linear variable in the entire cohort (HR 0.7; p = 0.005). Conclusion: We present a multi‐institutional case‐series of CIFS and long‐term follow‐up. ANC <1000 at time of diagnosis and recent chemotherapy (within 1 month of diagnosis) are associated with poorer survival, whereas a rising ANC >1000 is associated with improved survival at 12 months. Further prospective studies are needed to further define factors that affect outcomes.