Periostin Bests Eosinophil Count for Biomarker Predictability in ECRS

The utility of periostin as a biomarker for eosinophilic chronic rhinosinusitis (ECRS) has been demonstrated in a new study that investigated potential associations between peripheral blood eosinophils, serum periostin level, and histopathological and clinical findings, according to the results published in Allergology International.

“ECRS is an intractable disease and a significant health problem,” wrote the study authors. “However, many aspects of the pathology of ECRS remain unclear.”

In the study from Japan, patients included in this analysis (N = 59; 33 in the ECRS cohort and 26 in the non-ECRS cohort) had visited the Japanese Red Cross Wakayama Medical Center or the Tohoku Medical and Pharmaceutical University. Their mean (SD) overall age was 52.9 (12.4) years, most were male patients (78%), and they were classified according to Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) Study criteria. For this study, 70 or more eosinophils per field for 3 fields inspected under a microscope at 400-times magnification indicates presence of ECRS and CT findings were scored on a scale from 0 (mild mucosal thickening without fluid accumulation) to 2 (moderate or severe mucosal thickening with fluid accumulation causing complete opacification). Also, the JESREC score, according to the authors, “is the sum of scores for 4 items (unilateral or bilateral disease, presence of nasal polyps, CT findings, and peripheral blood eosinophil level), and a preliminary diagnosis of ECRS is made if the JESREC score is 11 points or higher.”

Overall, statistically significant differences were seen between the ECRS cohort and the non-ECRS cohort, respectively, for the following mean measures:

• Peripheral blood eosinophils: 7.7% (4.9%) vs 1.8% (1.5%) (P < .001)
• Serum periostin: 124.5 (65.5) vs 87.9 (29.4) ng/mL (P < .05)

In addition, there was a positive correlation between those 2 measures among the participants who had ECRS (r_s = 0.49; P < .05), but the same could not be said for the non-ECRS participants (r_s = –0.25; P > .05).

A subanalysis conducted among those within the ECRS cohort who had comorbid asthma compared with those who did not have asthma showed a statistically significantly higher serum periostin level among the former: 153.5 (82.1) vs 100.3 (33.9) ng/mL (P < .05). A similar difference was not seen in the non-ECRS cohort: 101.3 (49.4) vs 84.8 (23.2) ng/mL (P > .05).

When CT findings were considered in connection to peripheral blood eosinophil and serum periostin levels, respectively, correlations were not seen overall (r_s = 0.04; P > .05; and r_s = 0.13; P > .05), within the ECRS cohort (r_s = 0.23; P > .05; and r_s = 0.22; P > .05), or within the non-ECRS cohort (r_s = –0.44; P > .05; and r_s = -0.012; P > .05).

Another analysis looked at outcomes between those with either unilateral or bilateral nasal polyps for the overall cohort and within each patient group. Statistically significant differences were only seen in the overall cohort for mean serum periostin level, with this total being drastically lower among those with unilateral polyps: 88.0 (33.8) vs 116.0 (60.1) ng/mL (P < .05). Blood eosinophil levels per the nose findings did not differ significantly either among those with unilateral or bilateral polyps, respectively: 3.6% (2.4%) vs 5.9% (5.3%) (P > .05).

A receiver operating characteristic curve analysis was conducted to determine cutoff values for likelihood of postoperative nasal polyp recurrence. For serum periostin level, the area under the curve (AUC) was 0.95, with 92% sensitivity and 100% specificity, and the cutoff value was 130 ng/mL. Similar results were not seen for peripheral blood eosinophil level, in that the AUC was 0.73, with 69.2% sensitivity and 85.0% specificity; the cutoff value for this measure was 8.8%.

Of their findings, the study investigators wrote, “The serum periostin level was shown to be a useful biomarker for predicting postoperative recurrence of nasal polyps; however, serum periostin level is not easily measured at this time.”

Because of this conclusion, they strongly urge that future studies focus on this biomarker and optimizing its measurement for disease severity and postop recurrence.

Reference

Sato T, Ikeda H, Murakami K, Murakami K, Shirane S, Ohta N. Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity. Allergol Int. 2023;72(1):161-168. doi:10.1016/j.alit.2022.08.006