Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.
The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco. adnanechoaib@gmail.com.
Choaib
C
Adnane
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Taoufik
T
Adouly
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Amine
A
Khallouk
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Sami
S
Rouadi
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Redallah
R
Abada
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Mohamed
M
Roubal
Department of ENT, 20 Août Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
Mohamed
M
Mahtar
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D000066491:Clinical Decision-Making / Q000379:methods*; D016000:Cluster Analysis; D004724:Endoscopy; D004802:Eosinophilia / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery; D018579:Patient Selection; D010641:Phenotype; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Chronic rhinosinusitis; Cluster analysis; Endotype; Phenotype; Quality of life; SNOT-22
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