Abstract
BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy. However, the therapeutic response varies markedly between individuals. The objective of this study was to evaluate the diagnostic values of sinus computed tomography (CT) for GC-sensitivity in patients with CRSwNP.MethodsWe conducted a prospective, single-blinded study of 47 consecutive patients with CRSwNP. These patients were given a course of oral prednisone (30 mg daily for 14 days) and subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and GC-insensitive subgroups: Lund-Mackay scores, olfactory cleft (OC) scores, and blood eosinophil counts and ratio (percentage of the total white blood cells).Results25/47 (53.2%) and 29/47 (61.7%) patients were objectively and subjectively sensitive to GC therapy, respectively. The OC score and the blood eosinophil counts and ratio in GC-sensitive subgroup were significantly higher than those in GC-insensitive subgroup, defined either objectively or subjectively. Multivariate logistic regression revealed that OC score was independent risk factor for objective or subjective GC-sensitivity. The OC score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (the OC score AUC = 0.775 and 0.829, respectively). A OC score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP.ConclusionOur prospective findings validate the potential value of sinus CT scan in predicting GC-sensitivity in CRSwNP patients.
Highlights
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy
The subjects were classified as objectively GC-sensitive subgroup and objectively GC-insensitive subgroup after completion of GC prescription, based on the endoscopic score criterion of Milara et al [11, 12], we designated patients who are unable to reduce more than 1 point in the nasal polyp scoring system after oral corticosteroid management as GC-insensitive CRSwNP
To evaluate the subjective response to oral corticosteroids, we divided the subjects into subjectively GC-sensitive CRSwNP and subjectively GC-insensitive CRSwNP based on a similar system, namely patients who are unable to reduce more than 1 point in the total nasal symptom score (TNSS) system after oral corticosteroid management were classified as subjectively GC-insensitive CRSwNP
Summary
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy. CRS is primarily diagnosed through observation of symptoms and clinical signs and supplemented with computed tomography (CT) and nasal endoscopy. Based on the presence of nasal polyps during these diagnosis, CRS can be further classified into two subtypes: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). Among these CRS manifestations, CRSwNP is known to show a higher degree of disease severity and poorer response to medical and surgical therapy [1]. In China CRSwNP patients are presented with a more distinct pathogenic phenotype that involves neutrophilic accumulations and mixed Th1/Th2/Th17 response [6, 7], suggesting a more heterogeneous nature of CRSwNP in China
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