医学
队列
内科学
回顾性队列研究
阶段(地层学)
感觉神经母细胞瘤
病历
中性粒细胞减少症
儿科
外科
放射治疗
古生物学
毒性
生物
作者
Marie‐Ange Munyemana,Dorina Kallogjeri,Rebecca D. Chernock,Nyssa Fox Farrell,John S. Schneider,Jay F. Piccirillo,Lauren T. Roland
出处
期刊:JAMA otolaryngology-- head & neck surgery
[American Medical Association]
日期:2024-04-01
卷期号:150 (4): 328-328
被引量:1
标识
DOI:10.1001/jamaoto.2024.0042
摘要
Importance Despite the aggressive progression of fulminant acute invasive fungal sinusitis (AIFS), data on prognostic factors have been disparate, hindering the development of a staging system. A composite staging system may improve prognostication for patient counseling and conduct of clinical research. Objective To identify prognostically important factors in AIFS and to incorporate the factors into a comprehensive Functional Severity Staging System and Clinical Severity Staging System. Design, Setting, and Participants This retrospective cohort study included adult patients diagnosed with pathology-proven AIFS from June 1, 1992, to December 31, 2022, at Washington University Medical Center and Barnes-Jewish Hospital, a tertiary care center in St Louis, Missouri. Data were analyzed from April to July 2023. Main Outcome and Measures Sequential sequestration and conjunctive consolidation was used to develop a composite staging system to predict 6-month overall survival. Results Of 71 patients with pathology-proven AIFS over the 30-year period, the median (range) age of the cohort was 56 (19-63) years, and there were 47 (66%) male patients. The median (range) follow-up time was 2 (0-251) months. There were 28 patients alive within 6 months, for a 39% survival rate. Symptoms, comorbidity burden, and presence and duration of severe neutropenia were associated with 6-month survival and were consolidated into a 3-category Clinical Severity Staging System with 6-month survival of 75% for stage A (n = 16), 41% for stage B (n = 27), and 18% for stage C (n = 28). The discriminative power of the composite staging system was moderate (C statistic, 0.63). Conclusion and Relevance This cohort study supports the clinical importance of symptomatology, comorbidity burden, and prolonged severe neutropenia at the time of AIFS presentation. The composite clinical staging system may be useful for clinicians when counseling patients with AIFS and conducting clinical research.
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