Portal de Periódicos da CAPES

Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study

2015; Wiley; Volume: 70; Issue: 8 Linguagem: Inglês

10.1111/all.12644

1398-9995

T Tokunaga, Masafumi Sakashita, Haruna Takeda, Daiya Asaka, Sachio Takeno, Hiroki Ikeda, T. Nakayama, Narihito Seki, Shin Ito, Junichi Murata, Yasunori Sakuma, Naohiro Yoshida, Tetsuya Terada, Ichiro Morikura, Hiroshi Sakaida, Kenji Kondo, KYOKO TERAGUCHI, Mitsuhiro Okano, Nobuyoshi Otori, Mamoru Yoshikawa, K. Hirakawa, S. Haruna, T. Himi, Katsuhisa Ikeda, J. Ishitoya, Y. Iino, Ryo Kawata, Hideyuki Kawauchi, Masayoshi Kobayashi, Tatsuya Yamasoba, Takaki Miwa, Mitsuyoshi Urashima, Mayumi Tamari, Emiko Noguchi, Takahiro Ninomiya, Yoshimasa Imoto, Taiyo Morikawa, Kaori Tomita, Tetsuji Takabayashi, Shigeharu Fujieda,

Infectious Diseases and Mycology

Abstract Background Chronic rhinosinusitis ( CRS ) can be classified into CRS with nasal polyps ( CRS w NP ) and CRS without nasal polyps ( CRS s NP ). CRS w NP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS ( ECRS ), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS . Methods This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis ( JESREC ). We evaluated patients with CRS treated with endoscopic sinus surgery ( ESS ), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS . Results We analyzed 1716 patients treated with ESS . To diagnose ECRS , the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography ( CT ) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti‐inflammatory drugs intolerance were associated significantly with recurrence. Conclusion We subdivided CRS w NP in non‐ ECRS , mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.