title: Prognostic factors for survival in patients with acute invasive fungal rhinosinusitis.
abstract: BACKGROUND
  Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. There are few reports that demonstrate an improvement in the overall prognosis. Furthermore, definite prognostic factors related to patient survival remain unclear.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the various clinical factors related to survival of patients with AIFR.
  
  
  METHODS
  This is a retrospective case series with patients treated for AIFR between 1997 and 2013. A total of 45 patients with AIFR were enrolled for analysis. We evaluated demographics, clinical characteristics, and disease course.
  
  
  RESULTS
  Mean age of patients was 59.6 years. AIFR developed most commonly in patients with immunocompromised host, such as diabetes (n = 23) or hematologic malignancy (n = 17). There were two main genera of fungus, Aspergillus (n = 30) and Mucor (n = 14). Headache, cranial neuropathy, visual loss, and orbital pain were the most common presenting symptoms. Overall survival was 53%. Underlying hematologic malignancy and diabetes were significantly associated with overall survival, and accompanying severe neutropenia and elevated C-reactive protein (CRP) were also related to poor prognosis. Initial presentation with facial swelling, involvement of nasal septum, or shorter symptom duration was also associated with survival reduction. Multivariate analysis revealed that CRP more than 5.50 mg/dL (Hazard ratio [HR], 9.04; p = .003) was an independent prognostic factor in patients with AIFR.
  
  
  CONCLUSIONS
  Overall survival rate remained approximately 50% in patients with AIFR. The prognosis of AIFR is significantly influenced by underlying diseases, accompanying neutropenia, CRP levels, symptom duration, involvement of septum, and the presence of facial swelling. Elevation of CRP, in particular, was an independent predictor of poor outcomes and should be monitored appropriately.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun-Jin
authors.initials: HJ
authors.lastname: Cho
authors.forename: Min-Seok
authors.initials: MS
authors.lastname: Jang
authors.forename: Sang Duk
authors.initials: SD
authors.lastname: Hong
authors.forename: Seung-Kyu
authors.initials: SK
authors.lastname: Chung
authors.forename: Hyo Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Hun-Jong
authors.initials: HJ
authors.lastname: Dhong
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000401:mortality*; D012852:Sinusitis / Q000401:mortality*; D015996:Survival Rate
chemical_list: D002097:C-Reactive Protein