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Algorithm for CRS classification may predict recurrence risk, refractoriness

A diagnostic algorithm for classifying chronic rhinosinusitis demonstrated utility in determining refractoriness and recurrence risk for the condition, according to recent findings.

Shigeharu Fujieda, MD, of the department of otorhinolaryngology head and neck surgery at the University of Fukui, Japan and colleagues conducted a multicenter, retrospective study evaluating 1,715 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery (ESS) at 15 institutions between January 2007 and December 2009.

The researchers used the Japanese Epidemiologic Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) Scoring System to evaluate CT scans for unilateral or bilateral disease, the existence of nasal polyps, blood eosinophilia and dominant shadow of ethmoid sinuses. They gathered preoperative and medical data on all participants, and rhinology specialists preoperatively evaluated all patients for the following seven symptoms:

• nasal polyps,

• viscous rhinorrhea,

• postnasal drip,

• facial pain,

• hyposmia,

• anosmia, and

• closure of the olfactory cleft.

The researchers acquired mucosal tissues from the nasal polyps or polypoid lesions of the ethmoid cavities of patients during surgery. They used the Kaplan-Meier method to construct relapse-free survival curves of nasal polyps. Univariate/multivariate Cox proportional hazards models, using the duration of recurrence as the underlying time metric, were formulated to approximate CRS recurrence risk correlated with possible predictors. These variables included demographic and medical history, symptoms and signs, laboratory data and CT results.

A cutoff value of 11 or higher for the JESREC score was established to diagnose eosinophilic CRS (ECRS). The sensitivity of this criterion was 83% and the specificity was 66%. When applied to the patients in the study, the simulation found the following rates of recurrence: 12.7% for non-ECRS, 23.4% for mild ECRS, 31.1% for moderate ECRS, and 51.8% for severe ECRS. The following rates of refractoriness were determined: 3.3% for non-ECRS, 11.7% for mild ECRS, 16.6% for moderate ECRS, and 29.4% for severe ECRS.

Significant disparities between the four groups were observed in both recurrence rate and refractoriness (P<.001 for both). Most of the moderate and severe ECRS cases involved CRS with nasal polyps (93.7%). Factors significantly associated with recurrence included blood eosinophilia (>5%), ethmoid sinus disease identified by CT scan, bronchial asthma, and aspirin and nonsteroidal inflammatory drug intolerance.

According to the researchers, this algorithm may provide valuable information to clinicians about the refractoriness of CRS.

“This algorithm may allow clinicians to decide treatment strategies according to refractoriness before operation,” the researchers wrote.

Disclosure: The researchers report no relevant disclosures.