Study Identifies Predictors of Eosinophilic Disease in CRS With Nasal Polyps

Asthma history and olfactory, rhinorrhea, and nasal polyp endoscopy scores were identified as independent predictors of eosinophilic disease in Chinese patients with chronic rhinosinusitis with nasal polyps (CRSwNP), according to study findings published in International Forum of Allergy and Rhinology.

In the pathophysiology of CRSwNP, the degree of mucosal eosinophilia has been indicated to have a significant impact on immunopathologies, clinical manifestations, prognoses, and therapeutic strategies, so patients can be subclassified as having eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP).

“Compared with nonECRSwNP, ECRSwNP tends to have a higher recurrence rate after surgery and greater sensitivity to glucocorticoids.…Although histological examination remains the gold standard for the diagnosis of ECRSwNP, it is not commonly used to identify the inflammatory pattern of NPs via preoperative biopsy,” noted the study authors.

Prior research has indicated that comorbid asthma, olfactory dysfunction, and multiple, bilateral NPs in the middle meatus and olfactory cleft are characteristics of ECRSwNP.

“It remains important, however, to identify an economic, noninvasive, and rapid method of determining inflammatory endotypes to guide clinical practice and avoid unnecessary health expenditures,” the authors wrote.

They conducted a cross-sectional analysis to assess the predictive value of clinical parameters, including medical history, symptom profiles, and endoscopic findings, in the diagnosis of ECRSwNP.

A total of 502 patients with a diagnosis of CRSwNP who had undergone functional endoscopic sinus surgery (FESS) following a limited response to medication were recruited from the Beijing Tongren Hospital, Capital Medical University, Beijing, China, between October 2018 and October 2019.

Based on the degree of eosinophilic infiltration in nasal polyps, patients were classified into ECRSwNP (n = 290) or nonECRSwNP (n = 212) groups. Demographic characteristics, asthma history, severity of nasal symptoms (nasal obstruction, rhinorrhea, hyposmia, and facial pain/headache) according to the visual analog scale, and nasal polyp scores based on a polyp scoring system (0, no polyps; 3, severe polyposis) were recorded. A logistic regression analysis was also performed to screen for independent risk factors, and a model nomogram was constructed.

Between the 2 groups, the proportions of mild and moderate polyps were higher in the ECRSwNP group, whereas the proportion of severe polyps was higher in the nonECRSwNP group. The score of nasal polyps in the ECRSwNP group was significantly lower than that of the nonECRSwNP group (mean [SD], 2.076 [0.472] vs 2.259 [0.519]; P < .001).

Moreover, the percentage of asthmatic patients and the hyposmia, rhinorrhea, and total nasal symptom scores were significantly higher in ECRSwNP patients than in the nonECRSwNP group. There were no significant differences in terms of age, ethnicity, or the nasal obstruction and facial pain/headache scores between the 2 groups.

Logistic regression analysis further revealed that asthma history and hyposmia, rhinorrhea, and nasal polyp scores were independent predictors of ECRSwNP. A nomogram consisting of these 4 independent risk factors was constructed, with a concordance index of 0.808 (95% CI, 0.771-0.846), suggesting that it had good discriminative ability.

“The nomogram based on asthma history and olfactory, rhinorrhea, and nasal polyp scores could help predict ECRSwNP, providing a simple, fast, and practical way to distinguish ECRSwNP from nonECRSwNP cases in clinical practice,” concluded the researchers. “In the future, it will be necessary to further verify the effectiveness of the nomogram in patients of different ethnicities and from other geographic regions.”

Reference

Yu L, Jiang Y, Yan B, Fang G, Wang C, Zhang L. Predictive value of clinical characteristics in eosinophilic chronic rhinosinusitis with nasal polyps: a cross-sectional study in the Chinese population. Int Forum Allergy Rhinol. 2022;12(5):726-734. doi:10.1002/alr.22901