title: Symptom-Based Clustering in Chronic Rhinosinusitis Relates to History of Aspirin Sensitivity and Postsurgical Outcomes.
abstract: BACKGROUND
  Symptoms burden in chronic rhinosinusitis (CRS) may be assessed by interviews or by means of validated tools such as the 22-item SinoNasal Outcome Test (SNOT-22). However, when only the total SNOT-22 scores are used, the pattern of symptom distribution and heterogeneity in patient symptoms is lost.
  
  
  OBJECTIVE
  To use a standardized symptom assessment tool (SNOT-22) on preoperative symptoms to understand symptom heterogeneity in CRS and to aid in characterization of distinguishing clinical features between subgroups.
  
  
  METHODS
  This was a retrospective review of 97 surgical patients with CRS. Symptom-based clusters were derived on the basis of presurgical SNOT-22 scores using unsupervised analysis and network graphs. Comparison between clusters was performed for clinical and demographic parameters, postsurgical symptom scores, and presence or absence of a history of aspirin sensitivity.
  
  
  RESULTS
  Unsupervised analysis reveals coclustering of specific symptoms in the SNOT-22 tool. Using symptom-based clustering, patients with CRS were stratified into severe overall (mean total score, 90.8), severe sinonasal (score, 62), moderate sinonasal (score, 40), moderate nonsinonasal (score, 37) and mild sinonasal (score, 16) clusters. The last 2 clusters were associated with lack of history of aspirin sensitivity. The first cluster had a rapid relapse in symptoms postoperatively, and the last cluster demonstrated minimal symptomatic improvement after surgery.
  
  
  CONCLUSIONS
  Symptom-based clusters in CRS reveal a distinct grouping of symptom burden that may relate to aspirin sensitivity and treatment outcomes.
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn. Electronic address: Divekar.Rohit@mayo.edu.
authors.forename: Rohit
authors.initials: R
authors.lastname: Divekar
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Jay
authors.initials: J
authors.lastname: Jin
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: John
authors.initials: J
authors.lastname: Hagan
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rank
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Phoenix, Ariz.
authors.forename: Devyani
authors.initials: D
authors.lastname: Lal
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kita
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
authors.forename: Erin
authors.initials: E
authors.lastname: O'Brien
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects*; D002908:Chronic Disease; D016000:Cluster Analysis; D017281:Cost of Illness; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D057234:Preoperative Period; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: Aspirin exacerbated respiratory disease; Aspirin sensitivity; CRS symptoms; Chronic rhinosinusitis; SNOT-22