Novel scoring system and algorithm for classifying chronic rhinosinusitis: The JESREC Study

T. Tokunaga, M. Sakashita, T. Haruna, D. Asaka, S. Takeno, H. Ikeda, T. Nakayama, N. Seki, S. Ito, J. Murata, Y. Sakuma, N. Yoshida, T. Terada, I. Morikura, H. Sakaida, K. Kondo, K. Teraguchi, M. Okano, N. Otori, M. YoshikawaK. Hirakawa, S. Haruna, T. Himi, K. Ikeda, J. Ishitoya, Y. Iino, R. Kawata, H. Kawauchi, M. Kobayashi, T. Yamasoba, T. Miwa, M. Urashima, M. Tamari, E. Noguchi, T. Ninomiya, Y. Imoto, T. Morikawa, K. Tomita, T. Takabayashi, S. Fujieda

Research output: Contribution to journalArticle

141 Citations (Scopus)

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. Conclusion 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.

Original languageEnglish
Pages (from-to)995-1003
Number of pages9
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume70
Issue number8
DOIs
Publication statusPublished - Aug 1 2015

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Nasal Polyps
Eosinophilia
Ethmoid Sinus
Recurrence
Logistic Models
Tomography
Proportional Hazards Models
ROC Curve
Aspirin
Anti-Inflammatory Agents
Asthma
Retrospective Studies
Surveys and Questionnaires
Cytokines
Biopsy
Sensitivity and Specificity
Pharmaceutical Preparations

Keywords

  • chronic rhinosinusitis severity
  • clinical diagnostic criterion
  • endoscopic sinus surgery
  • eosinophilic infiltration
  • refractory chronic rhinosinusitis

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Novel scoring system and algorithm for classifying chronic rhinosinusitis : The JESREC Study. / Tokunaga, T.; Sakashita, M.; Haruna, T.; Asaka, D.; Takeno, S.; Ikeda, H.; Nakayama, T.; Seki, N.; Ito, S.; Murata, J.; Sakuma, Y.; Yoshida, N.; Terada, T.; Morikura, I.; Sakaida, H.; Kondo, K.; Teraguchi, K.; Okano, M.; Otori, N.; Yoshikawa, M.; Hirakawa, K.; Haruna, S.; Himi, T.; Ikeda, K.; Ishitoya, J.; Iino, Y.; Kawata, R.; Kawauchi, H.; Kobayashi, M.; Yamasoba, T.; Miwa, T.; Urashima, M.; Tamari, M.; Noguchi, E.; Ninomiya, T.; Imoto, Y.; Morikawa, T.; Tomita, K.; Takabayashi, T.; Fujieda, S.

In: Allergy: European Journal of Allergy and Clinical Immunology, Vol. 70, No. 8, 01.08.2015, p. 995-1003.

Research output: Contribution to journalArticle

Tokunaga, T, Sakashita, M, Haruna, T, Asaka, D, Takeno, S, Ikeda, H, Nakayama, T, Seki, N, Ito, S, Murata, J, Sakuma, Y, Yoshida, N, Terada, T, Morikura, I, Sakaida, H, Kondo, K, Teraguchi, K, Okano, M, Otori, N, Yoshikawa, M, Hirakawa, K, Haruna, S, Himi, T, Ikeda, K, Ishitoya, J, Iino, Y, Kawata, R, Kawauchi, H, Kobayashi, M, Yamasoba, T, Miwa, T, Urashima, M, Tamari, M, Noguchi, E, Ninomiya, T, Imoto, Y, Morikawa, T, Tomita, K, Takabayashi, T & Fujieda, S 2015, 'Novel scoring system and algorithm for classifying chronic rhinosinusitis: The JESREC Study', Allergy: European Journal of Allergy and Clinical Immunology, vol. 70, no. 8, pp. 995-1003. https://doi.org/10.1111/all.12644
Tokunaga, T. ; Sakashita, M. ; Haruna, T. ; Asaka, D. ; Takeno, S. ; Ikeda, H. ; Nakayama, T. ; Seki, N. ; Ito, S. ; Murata, J. ; Sakuma, Y. ; Yoshida, N. ; Terada, T. ; Morikura, I. ; Sakaida, H. ; Kondo, K. ; Teraguchi, K. ; Okano, M. ; Otori, N. ; Yoshikawa, M. ; Hirakawa, K. ; Haruna, S. ; Himi, T. ; Ikeda, K. ; Ishitoya, J. ; Iino, Y. ; Kawata, R. ; Kawauchi, H. ; Kobayashi, M. ; Yamasoba, T. ; Miwa, T. ; Urashima, M. ; Tamari, M. ; Noguchi, E. ; Ninomiya, T. ; Imoto, Y. ; Morikawa, T. ; Tomita, K. ; Takabayashi, T. ; Fujieda, S. / Novel scoring system and algorithm for classifying chronic rhinosinusitis : The JESREC Study. In: Allergy: European Journal of Allergy and Clinical Immunology. 2015 ; Vol. 70, No. 8. pp. 995-1003.
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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. Conclusion 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.",
keywords = "chronic rhinosinusitis severity, clinical diagnostic criterion, endoscopic sinus surgery, eosinophilic infiltration, refractory chronic rhinosinusitis",
author = "T. Tokunaga and M. Sakashita and T. Haruna and D. Asaka and S. Takeno and H. Ikeda and T. Nakayama and N. Seki and S. Ito and J. Murata and Y. Sakuma and N. Yoshida and T. Terada and I. Morikura and H. Sakaida and K. Kondo and K. Teraguchi and M. Okano and N. Otori and M. Yoshikawa and K. Hirakawa and S. Haruna and T. Himi and K. Ikeda and J. Ishitoya and Y. Iino and R. Kawata and H. Kawauchi and M. Kobayashi and T. Yamasoba and T. Miwa and M. Urashima and M. Tamari and E. Noguchi and T. Ninomiya and Y. Imoto and T. Morikawa and K. Tomita and T. Takabayashi and S. Fujieda",
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T1 - Novel scoring system and algorithm for classifying chronic rhinosinusitis

T2 - The JESREC Study

AU - Tokunaga, T.

AU - Sakashita, M.

AU - Haruna, T.

AU - Asaka, D.

AU - Takeno, S.

AU - Ikeda, H.

AU - Nakayama, T.

AU - Seki, N.

AU - Ito, S.

AU - Murata, J.

AU - Sakuma, Y.

AU - Yoshida, N.

AU - Terada, T.

AU - Morikura, I.

AU - Sakaida, H.

AU - Kondo, K.

AU - Teraguchi, K.

AU - Okano, M.

AU - Otori, N.

AU - Yoshikawa, M.

AU - Hirakawa, K.

AU - Haruna, S.

AU - Himi, T.

AU - Ikeda, K.

AU - Ishitoya, J.

AU - Iino, Y.

AU - Kawata, R.

AU - Kawauchi, H.

AU - Kobayashi, M.

AU - Yamasoba, T.

AU - Miwa, T.

AU - Urashima, M.

AU - Tamari, M.

AU - Noguchi, E.

AU - Ninomiya, T.

AU - Imoto, Y.

AU - Morikawa, T.

AU - Tomita, K.

AU - Takabayashi, T.

AU - Fujieda, S.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - 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. Conclusion 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.

AB - 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. Conclusion 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.

KW - chronic rhinosinusitis severity

KW - clinical diagnostic criterion

KW - endoscopic sinus surgery

KW - eosinophilic infiltration

KW - refractory chronic rhinosinusitis

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