Age Linked With Treatment Outcomes in Noneosinophilic CRS With Nasal Polyps

Outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may be associated with age and incidence of eosinophilic disease, according to study findings published in Scientific Reports.

Regarded by study authors as a heterogeneous disorder composed of many disease subtypes, CRSwNP has been suggested to have several clinical features linked with risk of polyp recurrence and other outcomes.

“Patients with tissue eosinophilia and high interleukin (IL)-5 levels have a higher prevalence of comorbid asthma and difficult-to-treat cases. For difficult-to-treat cases, additional surgical procedures, or medical treatment, such as biologics, may be required,” they noted.

“Very little is known about the risk factors associated with disease refractoriness in noneosinophilic polyps. Our previous studies have shown that treatment outcomes can vary with the age of patients with noneosinophilic polyps.”

In seeking to evaluate the association between age and the clinical and immunological parameters of CRSwNP, the researchers conducted a retrospective cohort study of the medical records of patients with CRSwNP who underwent bilateral functional ESS at Seoul National University Bundang Hospital in Republic of Korea between June 2017 and January 2020.

A total of 269 patients were divided into eosinophilic (n = 106) and noneosinophilic (n = 163) groups based on tissue eosinophilia, defined by eosinophils accounting for more than 20% of the total inflammatory cells.

Further stratification was applied by age, in which younger and older groups based on the age of 35 years were divided. Clinical characteristics including blood eosinophil, Lund Mackay score, and modifed Lund-Kennedy (mLK) scores were compared. Levels of 14 cytokines from the nasal tissues of an additional 78 patients were analyzed.

Among patients with eosinophilic CRSwNP, 10 (9.4%) were younger and 96 (90.6%) were older, whereas in the noneosinophilic group, 38 (23.3%) were younger and 125 (76.7%) were older. A strong association between age group and tissue eosinophilia status was identified (P = .004), with the prevalence of noneosinophilic CRSwNP shown to be signifcantly higher in younger patients than in older patients (79.2% vs 56.6%).

For noneosinophilic CRSwNP, younger patients had signifcantly lower mean (SD) preoperative blood eosinophils (3.5% [3.2%] vs 5.3% [5.0%]; P = .016) and higher mean mLK scores at 3 and 6 months post operatively compared with older patients (3 months: 2.9 [2.5] vs 1.5 [1.7]; P < .001; 6 months: 2.5 [1.9] vs 1.5 [1.8]; P < .045).

Furthemore, alpha-1 antitrypsin and IL-5 levels were significantly lower in younger patients than in older patients with noneosinophilic CRSwNP. No difference in clinical characteristics and cytokine levels were observed between the younger and older patients with eosinophilic CRSwNP.

“As this is a single center study, there may be a risk of selection bias,” cautioned the study authors. “Therefore, a larger cohort, perhaps a multicenter study, with long-term follow-up is warranted.”

Reference

Kim J-W, Won T-B, Woo H, et al. Age related non‑type 2 infammation and its association with treatment outcome in patients with chronic rhinosinusitis with nasal polyp in Korea. Sci Rep. 2022 Jan 31;12(1):1671. doi:10.1038/s41598-022-05614-z