title: Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP 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.
  
  
  CONCLUSIONS
  We subdivided CRSwNP 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.
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tokunaga
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sakashita
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Haruna
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Asaka
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, Hiroshima University, Hiroshima, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takeno
authors.affiliation: Department of Otorhinolaryngology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Otolaryngology, Sapporo Medical University, Hokkaido, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Seki
authors.affiliation: Department of Otorhinolaryngology, Juntendo University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Otorhinolaryngology, Juntendo University, Tokyo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Murata
authors.affiliation: Department of Otorhinolaryngology, Yokohama City Medical Center, Kanagawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Osaka Medical College, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Terada
authors.affiliation: Department of Otorhinolaryngology, Shimane University, Shimane, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Morikura
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sakaida
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Teraguchi
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Okano
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Otori
authors.affiliation: Department of Otorhinolaryngology, Toho University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yoshikawa
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, Hiroshima University, Hiroshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hirakawa
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Haruna
authors.affiliation: Department of Otolaryngology, Sapporo Medical University, Hokkaido, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Himi
authors.affiliation: Department of Otorhinolaryngology, Juntendo University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Otorhinolaryngology, Yokohama City Medical Center, Kanagawa, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Ishitoya
authors.affiliation: Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iino
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Osaka Medical College, Osaka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kawata
authors.affiliation: Department of Otorhinolaryngology, Shimane University, Shimane, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kawauchi
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamasoba
authors.affiliation: Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Miwa
authors.affiliation: Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Urashima
authors.affiliation: Laboratory for Respiratory Diseases, Center for Genomic Medicine, Institute of Physical and Chemical Research (RIKEN), Kanagawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tamari
authors.affiliation: Department of Medical Genetics, University of Tsukuba, Ibaraki, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Noguchi
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.|Department of Medical Genetics, University of Tsukuba, Ibaraki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Imoto
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Morikawa
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Takabayashi
authors.affiliation: Department of Otorhinolaryngology Head & Neck Surgery, University of Fukui, Fukui, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fujieda
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000465:Algorithms; D002908:Chronic Disease; D015331:Cohort Studies; D004802:Eosinophilia / Q000276:immunology; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012220:Rhinitis / Q000145:classification* / Q000453:epidemiology* / Q000276:immunology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012852:Sinusitis / Q000145:classification* / Q000453:epidemiology* / Q000276:immunology; D055815:Young Adult
keywords: chronic rhinosinusitis severity; clinical diagnostic criterion; endoscopic sinus surgery; eosinophilic infiltration; refractory chronic rhinosinusitis