Clinical factors associated with acute exacerbations of chronic rhinosinusitis

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:145

Article

Kwah, Jason H.¹  Somani, Shaan N.¹  Stevens, Whitney W.^1,2  Kern, Robert C.^1,2  Smith, Stephanie S.²  Welch, Kevin C.²  Conley, David B.²  Tan, Bruce K.²  Grammer, Leslie C.¹  Yang, Amy³  Schleimer, Robert P.^1,2  Peters, Anju T.^1,2 

[1] Northwestern Univ, Dept Med, Feinberg Sch Med, Div Allergy & Immunol, Chicago, IL 60611 USA

[2] Northwestern Univ, Dept Otolaryngol Head & Neck Surg, Feinberg Sch Med, Chicago, IL 60611 USA

[3] Northwestern Univ, Biostat Collaborat Ctr, Feinberg Sch Med, Chicago, IL 60611 USA

关键词: Chronic rhinosinusitis;    exacerbation;    antibiotics;    asthma;    allergic rhinitis;    eosinophils;    autoimmune disease;   

DOI  :  10.1016/j.jaci.2020.01.023

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free