Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype
Background Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic...
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| Veröffentlicht in: | International forum of allergy & rhinology 2023-01, Vol.13 (1), p.15-24 |
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| creator | Stein, Eli Schneider, Alexander L. Harmon, Regan Racette, Samuel D. Reddy, Abhita T. Price, Caroline P. E. Huang, Julia H. Kato, Atsushi Shintani‐Smith, Stephanie Conley, David B. Welch, Kevin C. Kern, Robert C. Tan, Bruce K. |
| description | Background
Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
Methods
At a visit 6–12 months post ESS, patients underwent endoscopy and completed the CRS‐PRO and SNOT‐22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN‐γ, ECP, and IL‐17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank‐sum and chi‐squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
Results
A total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS‐PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p |
| doi_str_mv | 10.1002/alr.23042 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9726991</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2760399081</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3732-c97f9b13d038dfc7d5b0a99cfc3883037b31d860b1c38a242f810046dbaa7a123</originalsourceid><addsrcrecordid>eNp1kVtrHCEUx6U0NCHNQ79AEfrSPGziZUbHl0IIvcFCQ2mfxVEnY5jVqWemYb9EPnPdnXRJAxXhHPXn_9wQekPJBSWEXZohXzBOKvYCnbBiVkI11cuDL8UxOgO4I2XVtK6pfIWOeS0kqRp2gh5ufIYAk48TdgFsb_Ktxylj7_zGYNNNvvjRJbBpDBZDiDNgmAuVtzhEPJoplM-A78PUY9vnFAuW-xDTng1TAFy2AUg2mMm7hTR42o4e010svo-wO79GR50ZwJ892lP089PHH9dfVutvn79eX61XlkvOVlbJTrWUO8Ib11np6pYYpWxnedNwwmXLqWsEaWm5MKxiXVN6VQnXGiMNZfwUfVh0x7ndeGdLBdkMesxhY_JWJxP0vy8x9Po2_dZKMqEULQLvHwVy-jV7mPSmdM8Pg4k-zaCZkBUhglSqoO-eoXdpzrGUp5kUhCtFmp3g-ULZnACy7w7JUKJ3g9Zl0Ho_6MK-fZr9gfw71gJcLsB9GPz2_0r6av19kfwDul-04g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2760399081</pqid></control><display><type>article</type><title>Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Stein, Eli ; Schneider, Alexander L. ; Harmon, Regan ; Racette, Samuel D. ; Reddy, Abhita T. ; Price, Caroline P. E. ; Huang, Julia H. ; Kato, Atsushi ; Shintani‐Smith, Stephanie ; Conley, David B. ; Welch, Kevin C. ; Kern, Robert C. ; Tan, Bruce K.</creator><creatorcontrib>Stein, Eli ; Schneider, Alexander L. ; Harmon, Regan ; Racette, Samuel D. ; Reddy, Abhita T. ; Price, Caroline P. E. ; Huang, Julia H. ; Kato, Atsushi ; Shintani‐Smith, Stephanie ; Conley, David B. ; Welch, Kevin C. ; Kern, Robert C. ; Tan, Bruce K.</creatorcontrib><description>Background
Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
Methods
At a visit 6–12 months post ESS, patients underwent endoscopy and completed the CRS‐PRO and SNOT‐22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN‐γ, ECP, and IL‐17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank‐sum and chi‐squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
Results
A total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS‐PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p < 0.001; respectively), and had higher post‐ESS IFN‐γ, ECP, and IL‐17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.
Conclusions
Post‐ESS discharge or edema in the absence of polyps was associated with higher patient‐reported outcome severity and was more strongly associated with type 1 or 3 inflammation.</description><identifier>ISSN: 2042-6976</identifier><identifier>EISSN: 2042-6984</identifier><identifier>DOI: 10.1002/alr.23042</identifier><identifier>PMID: 35670482</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>biomarker ; Chronic Disease ; CRSsNP ; CRSwNP ; Edema ; Endoscopy ; endotype ; Humans ; Inflammation ; Interleukin-17 ; Nasal Polyps - epidemiology ; Original ; Otolaryngology ; Patient Discharge ; Patients ; patient‐reported outcome measures ; Polyps ; Rhinitis ; Rhinitis - epidemiology ; Rhinosinusitis ; Sinusitis ; Sinusitis - epidemiology ; Surgery</subject><ispartof>International forum of allergy & rhinology, 2023-01, Vol.13 (1), p.15-24</ispartof><rights>2022 The Authors. published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.</rights><rights>2022 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3732-c97f9b13d038dfc7d5b0a99cfc3883037b31d860b1c38a242f810046dbaa7a123</citedby><cites>FETCH-LOGICAL-c3732-c97f9b13d038dfc7d5b0a99cfc3883037b31d860b1c38a242f810046dbaa7a123</cites><orcidid>0000-0001-9013-646X ; 0000-0002-9590-7419 ; 0000-0001-9210-5050 ; 0000-0002-0605-3993 ; 0000-0002-5569-7795</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Falr.23042$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Falr.23042$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35670482$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stein, Eli</creatorcontrib><creatorcontrib>Schneider, Alexander L.</creatorcontrib><creatorcontrib>Harmon, Regan</creatorcontrib><creatorcontrib>Racette, Samuel D.</creatorcontrib><creatorcontrib>Reddy, Abhita T.</creatorcontrib><creatorcontrib>Price, Caroline P. E.</creatorcontrib><creatorcontrib>Huang, Julia H.</creatorcontrib><creatorcontrib>Kato, Atsushi</creatorcontrib><creatorcontrib>Shintani‐Smith, Stephanie</creatorcontrib><creatorcontrib>Conley, David B.</creatorcontrib><creatorcontrib>Welch, Kevin C.</creatorcontrib><creatorcontrib>Kern, Robert C.</creatorcontrib><creatorcontrib>Tan, Bruce K.</creatorcontrib><title>Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype</title><title>International forum of allergy & rhinology</title><addtitle>Int Forum Allergy Rhinol</addtitle><description>Background
Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
Methods
At a visit 6–12 months post ESS, patients underwent endoscopy and completed the CRS‐PRO and SNOT‐22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN‐γ, ECP, and IL‐17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank‐sum and chi‐squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
Results
A total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS‐PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p < 0.001; respectively), and had higher post‐ESS IFN‐γ, ECP, and IL‐17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.
Conclusions
Post‐ESS discharge or edema in the absence of polyps was associated with higher patient‐reported outcome severity and was more strongly associated with type 1 or 3 inflammation.</description><subject>biomarker</subject><subject>Chronic Disease</subject><subject>CRSsNP</subject><subject>CRSwNP</subject><subject>Edema</subject><subject>Endoscopy</subject><subject>endotype</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Interleukin-17</subject><subject>Nasal Polyps - epidemiology</subject><subject>Original</subject><subject>Otolaryngology</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>patient‐reported outcome measures</subject><subject>Polyps</subject><subject>Rhinitis</subject><subject>Rhinitis - epidemiology</subject><subject>Rhinosinusitis</subject><subject>Sinusitis</subject><subject>Sinusitis - epidemiology</subject><subject>Surgery</subject><issn>2042-6976</issn><issn>2042-6984</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kVtrHCEUx6U0NCHNQ79AEfrSPGziZUbHl0IIvcFCQ2mfxVEnY5jVqWemYb9EPnPdnXRJAxXhHPXn_9wQekPJBSWEXZohXzBOKvYCnbBiVkI11cuDL8UxOgO4I2XVtK6pfIWOeS0kqRp2gh5ufIYAk48TdgFsb_Ktxylj7_zGYNNNvvjRJbBpDBZDiDNgmAuVtzhEPJoplM-A78PUY9vnFAuW-xDTng1TAFy2AUg2mMm7hTR42o4e010svo-wO79GR50ZwJ892lP089PHH9dfVutvn79eX61XlkvOVlbJTrWUO8Ib11np6pYYpWxnedNwwmXLqWsEaWm5MKxiXVN6VQnXGiMNZfwUfVh0x7ndeGdLBdkMesxhY_JWJxP0vy8x9Po2_dZKMqEULQLvHwVy-jV7mPSmdM8Pg4k-zaCZkBUhglSqoO-eoXdpzrGUp5kUhCtFmp3g-ULZnACy7w7JUKJ3g9Zl0Ho_6MK-fZr9gfw71gJcLsB9GPz2_0r6av19kfwDul-04g</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Stein, Eli</creator><creator>Schneider, Alexander L.</creator><creator>Harmon, Regan</creator><creator>Racette, Samuel D.</creator><creator>Reddy, Abhita T.</creator><creator>Price, Caroline P. E.</creator><creator>Huang, Julia H.</creator><creator>Kato, Atsushi</creator><creator>Shintani‐Smith, Stephanie</creator><creator>Conley, David B.</creator><creator>Welch, Kevin C.</creator><creator>Kern, Robert C.</creator><creator>Tan, Bruce K.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9013-646X</orcidid><orcidid>https://orcid.org/0000-0002-9590-7419</orcidid><orcidid>https://orcid.org/0000-0001-9210-5050</orcidid><orcidid>https://orcid.org/0000-0002-0605-3993</orcidid><orcidid>https://orcid.org/0000-0002-5569-7795</orcidid></search><sort><creationdate>202301</creationdate><title>Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype</title><author>Stein, Eli ; Schneider, Alexander L. ; Harmon, Regan ; Racette, Samuel D. ; Reddy, Abhita T. ; Price, Caroline P. E. ; Huang, Julia H. ; Kato, Atsushi ; Shintani‐Smith, Stephanie ; Conley, David B. ; Welch, Kevin C. ; Kern, Robert C. ; Tan, Bruce K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3732-c97f9b13d038dfc7d5b0a99cfc3883037b31d860b1c38a242f810046dbaa7a123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>biomarker</topic><topic>Chronic Disease</topic><topic>CRSsNP</topic><topic>CRSwNP</topic><topic>Edema</topic><topic>Endoscopy</topic><topic>endotype</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Interleukin-17</topic><topic>Nasal Polyps - epidemiology</topic><topic>Original</topic><topic>Otolaryngology</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>patient‐reported outcome measures</topic><topic>Polyps</topic><topic>Rhinitis</topic><topic>Rhinitis - epidemiology</topic><topic>Rhinosinusitis</topic><topic>Sinusitis</topic><topic>Sinusitis - epidemiology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stein, Eli</creatorcontrib><creatorcontrib>Schneider, Alexander L.</creatorcontrib><creatorcontrib>Harmon, Regan</creatorcontrib><creatorcontrib>Racette, Samuel D.</creatorcontrib><creatorcontrib>Reddy, Abhita T.</creatorcontrib><creatorcontrib>Price, Caroline P. E.</creatorcontrib><creatorcontrib>Huang, Julia H.</creatorcontrib><creatorcontrib>Kato, Atsushi</creatorcontrib><creatorcontrib>Shintani‐Smith, Stephanie</creatorcontrib><creatorcontrib>Conley, David B.</creatorcontrib><creatorcontrib>Welch, Kevin C.</creatorcontrib><creatorcontrib>Kern, Robert C.</creatorcontrib><creatorcontrib>Tan, Bruce K.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International forum of allergy & rhinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stein, Eli</au><au>Schneider, Alexander L.</au><au>Harmon, Regan</au><au>Racette, Samuel D.</au><au>Reddy, Abhita T.</au><au>Price, Caroline P. E.</au><au>Huang, Julia H.</au><au>Kato, Atsushi</au><au>Shintani‐Smith, Stephanie</au><au>Conley, David B.</au><au>Welch, Kevin C.</au><au>Kern, Robert C.</au><au>Tan, Bruce K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype</atitle><jtitle>International forum of allergy & rhinology</jtitle><addtitle>Int Forum Allergy Rhinol</addtitle><date>2023-01</date><risdate>2023</risdate><volume>13</volume><issue>1</issue><spage>15</spage><epage>24</epage><pages>15-24</pages><issn>2042-6976</issn><eissn>2042-6984</eissn><abstract>Background
Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
Methods
At a visit 6–12 months post ESS, patients underwent endoscopy and completed the CRS‐PRO and SNOT‐22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN‐γ, ECP, and IL‐17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank‐sum and chi‐squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
Results
A total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS‐PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p < 0.001; respectively), and had higher post‐ESS IFN‐γ, ECP, and IL‐17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.
Conclusions
Post‐ESS discharge or edema in the absence of polyps was associated with higher patient‐reported outcome severity and was more strongly associated with type 1 or 3 inflammation.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35670482</pmid><doi>10.1002/alr.23042</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9013-646X</orcidid><orcidid>https://orcid.org/0000-0002-9590-7419</orcidid><orcidid>https://orcid.org/0000-0001-9210-5050</orcidid><orcidid>https://orcid.org/0000-0002-0605-3993</orcidid><orcidid>https://orcid.org/0000-0002-5569-7795</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | biomarker Chronic Disease CRSsNP CRSwNP Edema Endoscopy endotype Humans Inflammation Interleukin-17 Nasal Polyps - epidemiology Original Otolaryngology Patient Discharge Patients patient‐reported outcome measures Polyps Rhinitis Rhinitis - epidemiology Rhinosinusitis Sinusitis Sinusitis - epidemiology Surgery |
| title | Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype |
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