Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. (18th October 2016)

• Record Type: Journal Article
• Authors: Autio, Timo J.; Koskenkorva, Timo; Leino, Tuomo K.; Koivunen, Petri; Alho, Olli‐Pekka
• Is Part Of: Laryngoscope. Volume 127:Number 2(2017)
• Page Start: E55
• Page End: E61
• Publication Date: 2016-10-18
• Subjects: Acute rhinosinusitis -- bacterial -- C‐reactive protein -- CRP -- high‐sensitive CRP -- procalcitonin -- nasal nitric oxide -- NO; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.26344
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objective: To illuminate the pathophysiology of acute rhinosinusitis (ARS) with sequential monitoring of inflammatory biomarkers during an ARS episode and to clarify their diagnostic usability in bacterial ARS. Study Design: Inception cohort study with 50 conscripts with ARS. Methods: We collected peripheral blood high‐sensitive C‐reactive protein (hs‐CRP), white blood cell (WBC), procalcitonin, and nasal nitric oxide (nNO) counts at 2 to 3 and 9 to 10 days of symptoms during an ARS episode. We simultaneously gathered various clinical parameters and microbiological samples. Bacterial ARS was confirmed with a positive culture of sinus aspirate. Results: Reciprocal correlations and a significant change in biomarker levels between the two visits suggest that ARS involves a local and systemic inflammatory response that was strongest at 2 to 3 days. High‐sensitive CRP and nNO reflected responses best (52% had increased CRP levels at 2–3 days; 66% had decreased nNO levels). White blood cell and procalcitonin counts rarely exceeded the reference range. Increased local and systemic inflammatory response were linked to multiple, adenoviral, or influenza A viral etiology or the detection of bacterial ARS. Local response correlated with imaging findings of wide paranasal sinus involvement and ostiomeatal complex occlusion. At 9 to 10 days, elevated (≥ 11 mg/L) and moderately elevated (≥ 49 mg/L) hs‐CRP predicted bacterial ARS well (likelihood ratio [LR]+ 3.3 and LR+ 15.8, respectively), but the sensitivity for both findings remained low. Conclusion: Acute rhinosinusitis (particularly bacterial ARS) involves a local and systemic inflammatory response that is strongest at the beginning of symptoms. Elevated hs‐CRP supports the diagnosis of bacterial ARS. Level of Evidence: 4. Laryngoscope, 2016 127:E55–E61, 2017