Cluster analysis and prediction of treatment outcomes for chronic rhinosinusitis

• Published in: Journal of allergy and clinical immunology 2016-04, Vol.137 (4), p.1054-1062
• Main Authors: Soler, Zachary M., MD, MSc, Hyer, J. Madison, MS, Rudmik, Luke, MD, MSc, Ramakrishnan, Viswanathan, PhD, Smith, Timothy L., MD, MPH, Schlosser, Rodney J., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Allergy and Immunology; Antibiotics; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Chronic rhinosinusitis; Clinical Decision-Making - methods; cluster; Cluster Analysis; Colleges & universities; Decision Support Techniques; Discriminant Analysis; Drug Therapy, Combination; Endoscopy; Female; Follow-Up Studies; Humans; Inflammation; Logistic Models; Male; Middle Aged; outcomes; prediction; Productivity; Prognosis; Prospective Studies; Quality of Life; Respiratory System Agents - therapeutic use; Rhinitis - drug therapy; Rhinitis - surgery; Sinuses; sinusitis; Sinusitis - drug therapy; Sinusitis - surgery; Sleep; Sleep apnea; Steroids; Surgery; treatment; Treatment Outcome; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2015.11.019

Background Current clinical classifications of chronic rhinosinusitis (CRS) have weak prognostic utility regarding treatment outcomes. Simplified discriminant analysis based on unsupervised clustering has identified novel phenotypic subgroups of CRS, but prognostic utility is unknown. Objective We sought to determine whether discriminant analysis allows prognostication in patients choosing surgery versus continued medical management. Methods A multi-institutional prospective study of patients with CRS in whom initial medical therapy failed who then self-selected continued medical management or surgical treatment was used to separate patients into 5 clusters based on a previously described discriminant analysis using total Sino-Nasal Outcome Test-22 (SNOT-22) score, age, and missed productivity. Patients completed the SNOT-22 at baseline and for 18 months of follow-up. Baseline demographic and objective measures included olfactory testing, computed tomography, and endoscopy scoring. SNOT-22 outcomes for surgical versus continued medical treatment were compared across clusters. Results Data were available on 690 patients. Baseline differences in demographics, comorbidities, objective disease measures, and patient-reported outcomes were similar to previous clustering reports. Three of 5 clusters identified by means of discriminant analysis had improved SNOT-22 outcomes with surgical intervention when compared with continued medical management (surgery was a mean of 21.2 points better across these 3 clusters at 6 months, P