Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study. (October 2020)

• Record Type: Journal Article
• Authors: Virkkula, P.; Penttilä, E.; Vento, S. I.; Myller, J.; Koskinen, A.; Hammarén-Malmi, S.; Laulajainen-Hongisto, A.; Hytönen, M.; Lilja, M.; Numminen, J.; Sillanpää, S.; Sahlman, J.; Toppila-Salmi, S.
• Is Part Of: Allergy & rhinology. Volume 11(2020)
• Publication Date: 2020-10
• Subjects: chronic rhinosinusitis -- computed tomography -- nasal polyp -- sinusitis; Allergy -- Periodicals; Otolaryngology -- Periodicals; Nose -- Diseases -- Periodicals; Allergy; Nose -- Diseases; Otolaryngology; Hypersensitivity -- Periodicals; Otolaryngology -- Periodicals; Nose Diseases -- Periodicals; Periodicals; Electronic journals; 616.97005
• DOI: 10.1177/2152656720956596
• Languages: English
• ISSNs: 2152-6575

Abstract

Background: Developing tools to identify chronic rhinosinusitis with nasal polyps (CRSwNP) patients requiring surgical treatment would help clinicians treat patients more effectively. The aim of this retrospective cross-sectional study was to identify cut-off values ​​for eosinophil percentage, nasal polyps (NP), and Lund-Mackay (LM) scores that may predict the need for surgical treatment in Finnish CRSwNP patients. Methods: Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19 were used. Data was collected from patient records and Lund-Mackay scores were determined from sinus computed tomography scans. The percentage of eosinophils was microscopically evaluated from the polyp samples available (n = 81). Associations were analyzed by Mann Whitney U test, and cut-off values by the area under the receiver operating characteristic curve (AUROC). Results: ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was associated significantly with ESS (p = 0.001), whereas peripheral blood eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05). AUROC values (95% CI) for detecting those needing ESS were for polyp eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67), p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp eosinophilia (>25%), the sensitivity and specificity were optimal for detecting the group needing ESS from the group not undergoing ESS. The cut-off value of blood eosinophil count (>0.26 × 10 9 /L) had relatively good, yet statistically insignificant (underpowered), predictive potential. Moderate cut-off values were found for endoscopic LM score (≥14/24) and NP score (≥4/8). Conclusions: Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level CRSwNP patients. A future challenge would be to find less invasive and cost-effective clinical factors predicting uncontrolled CRSwNP.