Mortality rate and predictive factors for invasive fungal rhinosinusitis: Experience in siriraj hospital

Objective: To elucidate the mortality rate and prognostic factors in patients with invasive fungal rhinosinusitis in Siriraj Hospital. Methods: Thirty-nine patients with a definitive diagnosis of invasive fungal rhinosinusitis were recruited from October 2003 to September 2014. The mortality rate was retrieved, and the impacts of underlying diseases, clinical presentation, disease extension, fungal types, antifungal drugs, and time to treatment were statistically analyzed. Results: The overall mortality rate was 23.1%. All patients except one were immunocompromised. Cranial nerve involvement was the most common symptom. The ethmoid sinus was the most commonly affected intranasal site (46.2%), and the majority of extranasal lesions were located in the orbit (17.9%). Most patients were affected by Aspergillus spp. (64.1%). Alteration of consciousness and periorbital pain were significant negative prognostic factors [adjusted odds ratio (95% confidence interval), 10.37 (1.31-82.07) and 8.67 (1.30-57.88), respectively]. Other factors such as time to treatment, age, and central nervous system involvement had no effect on mortality. Conclusion: The mortality rate of invasive fungal rhinosinusitis in this study was 23.1%. Negative prognostic factors were alteration of consciousness and periorbital pain. Clinicians must have a high index of suspicion for invasive fungal rhinosinusitis, and aggressive treatment should be considered.