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Table 3 Clinical risk factors for acute exacerbations in CRS

From: Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review

Author/year Study design Study participants Definition of an acute exacerbation Clinical risk factors Results Level of evidence
Rank, et al. (2010) [9] Retrospective cohort study CRS exacerbation Systemic antibiotics, systemic corticosteroid, plans for a semi-urgent surgical intervention, emergency department or urgent care visit, or a hospitalization for CRS. Winter months Twice as likely to present for a CRS exacerbation in winter months compared with spring, summer, or fall. 4
Banoub, et al. (2018) [11] Prospective Asthmatic CRS Sinus infections, CRS-related antibiotics use, CRS-related oral corticosteroids use. Lower ACT scores (Poor asthma control). AE are negatively associated with the level of asthma control in asthmatic CRS patients, independent of CRS symptom severity. 4
Kuiper, et al. (2018) [15] Prospective Acute exacerbations of NSS in patients with CRS 1.Self-reported medication use (antibiotics and oral corticosteroids) for worsened NSS; 2. duration (≥ 1 week) of worsened aggregate NSS; 3. duration (≥ 1 week) of worsened aggregate NSS and self-reported worsened purulence in the past 4 weeks. Current long-term CRS status, high body mass index, asthma, hay fever, sinus surgery history, and winter season. CRS status (current long-term, current recent, past, never), body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted acute exacerbations of NSS. 4
Ikeda, et al. (2011) [21] Prospective CRSwNP with asthma undergoing ESS Acute exacerbation of CRS defined by the presence of purulent sinonasal secretions in conjunction with sinus-related symptoms. Bacterial infection Positive culture was obtained in 10 out of 11 patients. 4
Kwah, et al. (2020) [22] Retrospective cohort study frequent exacerbations of CRS worsening sinus symptoms and CRS-related antibiotics usage Asthma, allergic rhinitis, eosinophil count ≥150/μL, and autoimmune disease Frequent AECRS was characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count ≥150/μL, autoimmune disease. 4
Phillips, et al. (2018) [23] Prospective CRS exacerbation CRS-related antibiotics usage, sinus infections. High SNOT-22 scores. SNOT-22 score is associated with the number of antibiotics which were highly correlated with the number of reported sinus infections. 4
  1. CRSwNP Chronic rhinosinusitis with nasal polyps, CRS Chronic rhinosinusitis, NSS Nasal and sinus symptoms, SNOT-22 The 22-item Sino- Nasal Outcome Test, ACT Asthma control test, AE Acute exacerbation, ESS Endoscopic sinus surgery