title: Acute invasive fungal rhinosinusitis: Survival analysis and the prognostic indicators.
abstract: BACKGROUND
  Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of the paranasal sinuses and surrounding structures that is almost always seen in patients who are immunocompromised. Despite the use of newer antifungal treatments and early diagnosis, the prognosis of AIFR does not improve significantly. Due to the higher incidence of patients who are immunocompromised and have more complex disease, AIFR is a growing medical issue in tertiary medical centers.
  
  
  OBJECTIVE
  The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery.
  
  
  METHODS
  Between October 2009 and November 2014, 37 patients who underwent surgery for AIFR at a tertiary care university hospital were included in the study. Overall survival and disease-specific mortality and survival rates were calculated to estimate survival function. The impact of age, sex, underlying disease, extent of AIFR, applied medical treatment, and causative species (mucormycosis, aspergillosis) were also taken into consideration. Also, the effect of a variety of laboratory parameters, such as hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, and C-reactive protein (CRP) levels, to survival were evaluated.
  
  
  RESULTS
  The median follow-up time was 58 days (interquartile range = 304). Overall and disease-specific mortality rates were 64.9 and 51.4%, respectively. Fever was the most common symptom (86.5%), along with nasal obstruction and/or fullness (48.6%) and epistaxis (48.6%). Age and sex did not have a significant impact on survival (p > 0.05). Palate involvement was significantly associated with mortality (p < 0.05). According to the results of Cox, regression analysis for disease-specific mortality rate, leukocyte and neutrophil counts as well as CRP levels had a significant effect on survival function (p < 0.05).
  
  
  CONCLUSIONS
  Palatal involvement was associated with a higher mortality in our study. Also, leukocyte counts, neutrophile counts, and CRP values had a significant impact on survival function. The reversal of the underlying disease and immunosuppression is as important as the medical and surgical treatment.
authors.affiliation: Otolaryngology Department, Ege University Medical School, Izmir, Turkey.
authors.forename: Sercan
authors.initials: S
authors.lastname: Gode
authors.forename: Goksel
authors.initials: G
authors.lastname: Turhal
authors.forename: Kerem
authors.initials: K
authors.lastname: Ozturk
authors.forename: Abdulhalim
authors.initials: A
authors.lastname: Aysel
authors.forename: Rasit
authors.initials: R
authors.lastname: Midilli
authors.forename: Bulent
authors.initials: B
authors.lastname: Karci
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000382:microbiology / Q000401:mortality*; D012852:Sinusitis / Q000382:microbiology / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult