Premium
A multi‐institutional review of outcomes in biopsy‐proven acute invasive fungal sinusitis
Author(s) -
Wandell Grace M.,
Miller Craig,
Rathor Aakanksha,
Wai Travis Hee,
Guyer Richard A.,
Schmidt Rodney A.,
Turner Justin H.,
Hwang Peter H.,
Davis Greg E.,
Humphreys Ian M.
Publication year - 2018
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22172
Subject(s) - medicine , univariate analysis , malignancy , fungal sinusitis , multivariate analysis , hazard ratio , sinusitis , biopsy , hematologic malignancy , proportional hazards model , absolute neutrophil count , chemotherapy , surgery , gastroenterology , neutropenia , confidence interval
Background Acute invasive fungal sinusitis (AIFS) is a rare, aggressive infection occurring in immunocompromised patients. In this study we examined factors that affect survival in AIFS, and whether immune‐stimulating therapies (IST) improve survival. Methods Pathology records of biopsy‐proven AIFS were reviewed from 3 academic institutions from 1995 to 2016. Univariate and multivariate Cox regressions were performed at 1 and 3 months from diagnosis. Results One hundred fourteen patients were included; 45 received IST. In the univariate analysis, the following factors were associated with worse survival: hematologic malignancy (3‐month hazard ratio [HR], 3.7; p = 0.01); recent chemotherapy (within 1 month of AIFS diagnosis) (3‐month HR, 2.3; p = 0.02); recent bone marrow transplant (BMT) (3‐month HR, 2.5; p = 0.02); and infection with atypical fungi (1‐month HR, 3.1; p = 0.04). The following were associated with improved survival in univariate analysis: increasing A1c% (1‐month HR, 0.7; p = 0.01) and surgical debridement (1‐month HR, 0.1; p = 0.001). One third of patients with a hematologic malignancy had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. ANC was not associated with prognosis in these patients. The following were associated with worse survival in multivariate analyses: hematologic malignancy; recent chemotherapy; atypical organisms; and cavernous sinus extension. In multivariate analyses, IST was associated with a 70% reduction in mortality at 1 month ( p = 0.02). Conclusion We presented the largest series of AIFS. Further studies are needed to examine the importance of ANC in diagnosis and prognosis. Patients diagnosed with atypical organisms may be at higher risk of death. IST likely improves short‐term survival, but prospective studies are needed.