Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps: A Comparison in Patients With or Without NERD

Lilja, Markus; Koskinen, Anni; Virkkula, Paula; Vento, Seija; Myller, Jyri; Hammarén‐Malmi, Sari; Laulajainen‐Hongisto, Anu; Hytönen, Maija; Mäkitie, Antti; Numminen, Jura; Sillanpää, Saara; Raitiola, Hannu; Rautiainen, Markus; Toppila‐Salmi, Sanna

doi:10.1177/21526567211003844

Cited by 18 publications

(26 citation statements)

References 41 publications

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“…The current study showed that CRSwNP, asthma, and NERD are important predictors of revision ESS also at the individual level. In accordance to this, previous studies have demonstrated on hospital population level that several factors are associated with the CRS recurrence and/or revision ESS, such as CRSwNP, asthma, AR, NERD, eosinophilia and smoking 1,7,23,24 . CRSwNP patients with co-morbid asthma and/or NERD have an increased risk for recurrence and revision ESS, although these patients seem benefit from initial ESS 13,19,[25][26][27] .…”

Section: Discussionsupporting

confidence: 76%

“…CRSwNP patients with co-morbid asthma and/or NERD have an increased risk for recurrence and revision ESS, although these patients seem benefit from initial ESS 13,19,[25][26][27] . This may reflect a more severe disease, with usually co-morbid NERD, anosmia, Type 2 high eosinophilic inflammation, and a greater tendency of polyp re-growth 23,[28][29][30][31][32][33][34][35][36][37] . When performing SFS, Immunodeficiency or its suspicion showed also to one of the top ten predictors by all three classifiers.…”

Section: Discussionmentioning

confidence: 99%

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Using machine learning for personalized prediction of revision paranasal sinus surgery

Nuutinen

Haukka

Virkkula

et al. 2021

Preprint

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Background: Uncontrolled chronic rhinosinusitis (CRS) needing consideration of surgery is a growing health problem yet its risk factors at individual level are not known. Our aim was to examine risk factors of revision endoscopic sinus surgery (ESS) at the individual level by using artificial intelligence. Methods: Demographic and visit variables were collected from electronic health records (EHR) of 790 operated CRS patients. The effect of variables on the prediction accuracy of revision ESS was examined at the individual level via machine learning models. Results: Revision ESS was performed to 114 (14.7%) CRS patients. The logistic regression, gradient boosting and random forest classifiers had similar performance (AUC values .746, .745 and .747, respectively) for predicting revision ESS. The best performance was yielded by using logistic regression and long predictor data retrieval time (AUC .809, precision 36%, sensitivity 70%) as compared with data collection time from baseline visit until 0, 3 and 6 months after the baseline ESS (AUC values .668, .717 and .746, respectively). The number of visits, number of days from the baseline visit to the baseline ESS, age, CRS with nasal polyps (CRSwNP), asthma, NERD and immunodeficiency or its suspicion were associated with revision ESS. Age and the number of visits before baseline ESS had non-linear effects for the predictions. Conclusions: Intelligent data analysis found important predictors of revision ESS at the individual level, such as visit frequency, age, Type 2 high diseases and immunodeficiency or its suspicion.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Using machine learning for personalized prediction of revision paranasal sinus surgery

Nuutinen

Haukka

Virkkula

et al. 2021

Preprint

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“…Our study also showed that CRSwNP, asthma and NERD represent important predictors of revision ESS at the individual level. In accordance with this, previous studies demonstrated at the hospital population level that several factors associate with CRS recurrence and/or revision ESS, including CRSwNP, asthma, allergic rhinitis, NERD, eosinophilia and smoking [1,13,57,58]. CRSwNP patients with a comorbidity of asthma and/or NERD carry an increased risk for recurrence and revision ESS, although these patients appear to benefit from an initial ESS [19,41,[59][60][61].…”

Section: Plos Onesupporting

confidence: 71%

“…Furthermore, data were lacking for some other important factors, such as postoperative treatment, validated symptoms, endoscopic nasal polyp score, medication, the Lund Mackay score for sinus computed tomography scans, smoking status, eosinophils and the extent of baseline ESS. Yet, some of these variables, such as smoking [13] or total ethmoidectomy, have not emerged as strong predictors of revision ESS compared with Type 2 high diseases [57] in our previous studies. That said, we acknowledge that the inclusion of more variables and additional cases would most likely improve our estimates.…”

Section: Plos Onementioning

confidence: 57%

“…CRSwNP patients with a comorbidity of asthma and/or NERD carry an increased risk for recurrence and revision ESS, although these patients appear to benefit from an initial ESS [19,41,[59][60][61]. This finding may reflect more severe disease, typically presenting with comorbidities for NERD, anosmia, Type 2 high eosinophilic inflammation and a higher likelihood of polyp regrowth [5,57,[62][63][64][65][66][67][68][69][70]. In SFS, immunodeficiency or a suspicion of it also emerged as one of the top ten predictors in all three classifiers.…”

Section: Plos Onementioning

confidence: 99%

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Using machine learning for the personalised prediction of revision endoscopic sinus surgery

et al. 2022

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Background Revision endoscopic sinus surgery (ESS) is often considered for chronic rhinosinusitis (CRS) if maximal conservative treatment and baseline ESS prove insufficient. Emerging research outlines the risk factors of revision ESS. However, accurately predicting revision ESS at the individual level remains uncertain. This study aims to examine the prediction accuracy of revision ESS and to identify the effects of risk factors at the individual level. Methods We collected demographic and clinical variables from the electronic health records of 767 surgical CRS patients ≥16 years of age. Revision ESS was performed on 111 (14.5%) patients. The prediction accuracy of revision ESS was examined by training and validating different machine learning models, while the effects of variables were analysed using the Shapley values and partial dependence plots. Results The logistic regression, gradient boosting and random forest classifiers performed similarly in predicting revision ESS. Area under the receiving operating characteristic curve (AUROC) values were 0.744, 0.741 and 0.730, respectively, using data collected from the baseline visit until six months after baseline ESS. The length of time during which data were collected improved the prediction performance. For data collection times of 0, 3, 6 and 12 months after baseline ESS, AUROC values for the logistic regression were 0.682, 0.715, 0.744 and 0.784, respectively. The number of visits before or after baseline ESS, the number of days from the baseline visit to the baseline ESS, patient age, CRS with nasal polyps (CRSwNP), asthma, non-steroidal anti-inflammatory drug exacerbated respiratory disease and immunodeficiency or suspicion of it all associated with revision ESS. Patient age and number of visits before baseline ESS carried non-linear effects for predictions. Conclusions Intelligent data analysis identified important predictors of revision ESS at the individual level, such as the frequency of clinical visits, patient age, Type 2 high diseases and immunodeficiency or a suspicion of it.

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The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland

Toppila‐Salmi

Hällfors²,

Aakko³

et al. 2022

Clinical & Translational All

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Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is commonly associated with asthma. Treatment of CRSwNP includes intranasal and systemic corticosteroids, with non‐responsive patients commonly considered for endoscopic sinus surgery (ESS). This nationwide register‐based study evaluated the incidence, prevalence, and treatment burden of CRSwNP in Finland, and their association with the presence and severity of comorbid asthma. Methods Electronic health records of patients diagnosed with CRSwNP between 1.1.2012 and 31.12.2018 in Finnish specialty and primary care were included in the study. The patients were divided into subgroups based on presence, severity, and control of asthma: no asthma, mild to moderate asthma, severe controlled asthma, and severe uncontrolled asthma. A mean cumulative count of ESS was calculated over time per subgroup. Results The prevalence of CRSwNP increased from 602.2 to 856.7 patients per 100,000 population between years 2012 and 2019 (p < 0.001). A total of 18,563 patients (59.9% male) had incident CRSwNP between 2012 and 2019, with 27% having asthma, 6% having severe asthma, and 1.5% having severe uncontrolled asthma. In the no asthma, severe controlled asthma, and severe uncontrolled asthma subgroups, systemic corticosteroids were used by 54.1%, 94.9% and 99.3% (p < 0.001), respectively, while the ESS count 3 years post diagnosis was 0.49, 0.68 and 0.80, respectively. Conclusions The prevalence of CRSwNP showed a significant increase in the recent decade in Finland. Comorbid asthma, and in particular severe asthma, increased the probability of receiving systemic corticosteroids and undergoing ESS. Thus, improved management of CRSwNP in patients with comorbid asthma is urgently needed.

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Factors Affecting the Control of Chronic Rhinosinusitis With Nasal Polyps: A Comparison in Patients With or Without NERD

Cited by 18 publications

References 41 publications

Using machine learning for personalized prediction of revision paranasal sinus surgery

Using machine learning for personalized prediction of revision paranasal sinus surgery

Using machine learning for the personalised prediction of revision endoscopic sinus surgery

The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland

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