Using postoperative SNOT-22 to help predict the probability of revision sinus surgery

Rudmik, Luke; Soler, Zachary M.; Hopkins, Claire

doi:10.4193/rhino15.284

Cited by 14 publications

(9 citation statements)

References 15 publications

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“…Several clinical markers raising the risk of recurrence have been reported: tissue eosinophilia, 3 , 23 – 25 serum eosinophilia, 3 high computed tomography (CT) scores, 1 , 3 , 26 higher preoperative endoscopic Lund-Kennedy scores for polyposis, 27 radiological inflammatory findings in frontal sinuses 17 and changes in SNOT-22 scoring after surgery. 28 …”

Section: Introductionmentioning

confidence: 99%

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Virkkula

Penttilä

Vento

et al. 2020

Allergy�Rhinol (Providence)

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Background Developing tools to identify chronic rhinosinusitis with nasal polyps (CRSwNP) patients requiring surgical treatment would help clinicians treat patients more effectively. The aim of this retrospective cross-sectional study was to identify cut-off values for eosinophil percentage, nasal polyps (NP), and Lund-Mackay (LM) scores that may predict the need for surgical treatment in Finnish CRSwNP patients. Methods Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19 were used. Data was collected from patient records and Lund-Mackay scores were determined from sinus computed tomography scans. The percentage of eosinophils was microscopically evaluated from the polyp samples available (n = 81). Associations were analyzed by Mann Whitney U test, and cut-off values by the area under the receiver operating characteristic curve (AUROC). Results ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was associated significantly with ESS (p = 0.001), whereas peripheral blood eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05). AUROC values (95% CI) for detecting those needing ESS were for polyp eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67), p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp eosinophilia (>25%), the sensitivity and specificity were optimal for detecting the group needing ESS from the group not undergoing ESS. The cut-off value of blood eosinophil count (>0.26 × 109/L) had relatively good, yet statistically insignificant (underpowered), predictive potential. Moderate cut-off values were found for endoscopic LM score (≥14/24) and NP score (≥4/8). Conclusions Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level CRSwNP patients. A future challenge would be to find less invasive and cost-effective clinical factors predicting uncontrolled CRSwNP.

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Section: Introductionmentioning

confidence: 99%

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Virkkula

Penttilä

Vento

et al. 2020

Allergy�Rhinol (Providence)

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“…After informed consent was obtained each participant completed a copy of the Sino-Nasal Outcome Test-22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and 36-Item Short Form Survey (SF-36). The SNOT-22 is a questionnaire consisting of 22 questions evaluating a range of symptoms experienced by suffers of nasal disease (24). The NOSE questionnaire consists of five questions which predominantly focus on evaluating breathing difficulties (25).…”

Section: Methodsmentioning

confidence: 99%

Dysregulated Maresin Concentrations in Plasma and Nasal Secretions From Patients With Chronic Rhinosinusitis

et al. 2021

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The mechanisms that lead to disease onset and propagation in patients with chronic rhinosinusitis (CRS) are not fully elucidated. Maresins (MaR) are a family of essential fatty acid-derived lipid mediators that play a central role in the regulation of inflammation with several studies demonstrating that these mediators display protective activities in airway inflammation. Therefore, in the present studies we evaluated whether concentrations of these mediators were altered in both peripheral blood and nasal secretions from CRS patients. Herein, we focused on patients with CRS that also develop nasal polyps (CRSwNP), given that therapeutic options for the treatment of these patients are limited. Thereby, insights into disease mechanisms in these patients may help design more effective treatments. For this purpose, we compared maresin concentrations from CRSwNP patients with those found in healthy volunteers or patients with an upper respiratory tract infection (URTI), as a self-resolving inflammatory condition. Using liquid chromatography tandem mass spectrometry, we found that MaR concentrations were significantly decreased in plasma from patients with CRSwNP when compared to healthy volunteers. MaR concentrations were observed to be significantly upregulated in nasal secretions from patients with CRSwNP when compared with both healthy volunteers and URTI subjects. Concentration of these mediators in both plasma and nasal secretions from CRSwNP patients were positively correlated with quality-of-life scores in these patients. Assessment of the concentrations of other pro-resolving and pro-inflammatory lipid mediators (LM) demonstrated that there was a general shift in LM levels in both plasma and nasal secretions from CRSwNP when compared with healthy volunteers and URTI subjects. Of note, incubation of peripheral blood cells from CRSwNP patients with MaR1 downregulated the expression of activation markers on peripheral blood phagocytes, including CD41 and CD62P, markers of platelet-leukocyte heterotypic aggregates. Together these findings demonstrate that both local and systemic LM concentrations, in particularly those of the MaR family, become altered in patients with CRSwNP. They also suggest that therapeutics designed around MaR1 may be useful in regulating the activation of phagocytes in patients with CRSwNP thereby potentially also limiting the local inflammatory response in these patients.

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“…as Cox's proportional hazard models [13,15,16] or logistic regression models [14,15,18,20]. Such studies have assumed associations are linear and that an alpha error <5% indicates the importance of a predictor.…”

Section: Plos Onementioning

confidence: 99%

“…Revision ESS risk was previously studied at the population level using Cox's proportional hazard [13,15,16] or logistic regression [14,15,18,20] models, which usually assume associations are linear and that an alpha error <5% indicates the importance of a predictor. Using these assumptions, previous studies have demonstrated that a younger age associated with revision ESS [13,66].…”

Section: Plos Onementioning

confidence: 99%

“…A substantial number of studies have identified the risk factors of revision ESS [13][14][15][16][17][18][19][20][21], in studies varying according to sample size (n = 66 [21] vs. n = 61 000 [15]), data collection methods (large retrospective database [15] vs. prospective questionnaires [14]) or geographic location (USA [15], Australia [22] and Finland [13]). Commonly recognised risk factors include nasal polyps, asthma, allergy, non-steroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (NERD) and a previous ESS.…”

Section: Introductionmentioning

confidence: 99%

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Using machine learning for the personalised prediction of revision endoscopic sinus surgery

et al. 2022

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Background Revision endoscopic sinus surgery (ESS) is often considered for chronic rhinosinusitis (CRS) if maximal conservative treatment and baseline ESS prove insufficient. Emerging research outlines the risk factors of revision ESS. However, accurately predicting revision ESS at the individual level remains uncertain. This study aims to examine the prediction accuracy of revision ESS and to identify the effects of risk factors at the individual level. Methods We collected demographic and clinical variables from the electronic health records of 767 surgical CRS patients ≥16 years of age. Revision ESS was performed on 111 (14.5%) patients. The prediction accuracy of revision ESS was examined by training and validating different machine learning models, while the effects of variables were analysed using the Shapley values and partial dependence plots. Results The logistic regression, gradient boosting and random forest classifiers performed similarly in predicting revision ESS. Area under the receiving operating characteristic curve (AUROC) values were 0.744, 0.741 and 0.730, respectively, using data collected from the baseline visit until six months after baseline ESS. The length of time during which data were collected improved the prediction performance. For data collection times of 0, 3, 6 and 12 months after baseline ESS, AUROC values for the logistic regression were 0.682, 0.715, 0.744 and 0.784, respectively. The number of visits before or after baseline ESS, the number of days from the baseline visit to the baseline ESS, patient age, CRS with nasal polyps (CRSwNP), asthma, non-steroidal anti-inflammatory drug exacerbated respiratory disease and immunodeficiency or suspicion of it all associated with revision ESS. Patient age and number of visits before baseline ESS carried non-linear effects for predictions. Conclusions Intelligent data analysis identified important predictors of revision ESS at the individual level, such as the frequency of clinical visits, patient age, Type 2 high diseases and immunodeficiency or a suspicion of it.

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Using postoperative SNOT-22 to help predict the probability of revision sinus surgery

Cited by 14 publications

References 15 publications

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Dysregulated Maresin Concentrations in Plasma and Nasal Secretions From Patients With Chronic Rhinosinusitis

Using machine learning for the personalised prediction of revision endoscopic sinus surgery

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