Systemic Predictors of Eosinophilic Chronic Rhinosinusitis

Jacqueline Ho, Aneeza Khairiyah Wan Hamizan, Raquel Alvarado, Janet Rimmer, William A. Sewell, Richard J. Harvey

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective: The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods: A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results: 345 patients (48.1% female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7%) identified as eCRS, 41% with asthma and 47% CRS with nasal polyps. eCRS patients were more likely to have asthma (P <.01) and nasal polyps (P <.01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P <.01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P <.01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P =.03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9%, specificity 78.4%, area under the curve [AUC]: 0.792, P <.01). eCRS was predicted at eosinophil above 4.27% of total WCC (sensitivity 64.1%, specificity 88.5%, AUC 0.797; P <.01; positive predictive value 89.2%, negative predictive value 62.4%, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion: eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27% of total WCC), and lower ESR when compared with non-eCRS.

Original languageEnglish
Pages (from-to)252-257
Number of pages6
JournalAmerican Journal of Rhinology and Allergy
Volume32
Issue number4
DOIs
Publication statusPublished - 1 Jul 2018

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Eosinophils
Immunoglobulin E
Blood Sedimentation
Asthma
Cell Count
Biomarkers
Nasal Polyps
Hematologic Tests
C-Reactive Protein
Cross-Sectional Studies
Inflammation
Biopsy
Serum

Keywords

  • adult
  • atopy
  • biomarkers
  • blood tests
  • chronic rhinosinusitis
  • cross-sectional studies
  • diagnosis
  • eosinophilic chronic rhinosinusitis
  • eosinophils
  • human

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Systemic Predictors of Eosinophilic Chronic Rhinosinusitis. / Ho, Jacqueline; Wan Hamizan, Aneeza Khairiyah; Alvarado, Raquel; Rimmer, Janet; Sewell, William A.; Harvey, Richard J.

In: American Journal of Rhinology and Allergy, Vol. 32, No. 4, 01.07.2018, p. 252-257.

Research output: Contribution to journalArticle

Ho, Jacqueline ; Wan Hamizan, Aneeza Khairiyah ; Alvarado, Raquel ; Rimmer, Janet ; Sewell, William A. ; Harvey, Richard J. / Systemic Predictors of Eosinophilic Chronic Rhinosinusitis. In: American Journal of Rhinology and Allergy. 2018 ; Vol. 32, No. 4. pp. 252-257.
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abstract = "Background: Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective: The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods: A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results: 345 patients (48.1{\%} female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7{\%}) identified as eCRS, 41{\%} with asthma and 47{\%} CRS with nasal polyps. eCRS patients were more likely to have asthma (P <.01) and nasal polyps (P <.01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P <.01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P <.01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P =.03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9{\%}, specificity 78.4{\%}, area under the curve [AUC]: 0.792, P <.01). eCRS was predicted at eosinophil above 4.27{\%} of total WCC (sensitivity 64.1{\%}, specificity 88.5{\%}, AUC 0.797; P <.01; positive predictive value 89.2{\%}, negative predictive value 62.4{\%}, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion: eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27{\%} of total WCC), and lower ESR when compared with non-eCRS.",
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T1 - Systemic Predictors of Eosinophilic Chronic Rhinosinusitis

AU - Ho, Jacqueline

AU - Wan Hamizan, Aneeza Khairiyah

AU - Alvarado, Raquel

AU - Rimmer, Janet

AU - Sewell, William A.

AU - Harvey, Richard J.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective: The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods: A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results: 345 patients (48.1% female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7%) identified as eCRS, 41% with asthma and 47% CRS with nasal polyps. eCRS patients were more likely to have asthma (P <.01) and nasal polyps (P <.01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P <.01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P <.01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P =.03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9%, specificity 78.4%, area under the curve [AUC]: 0.792, P <.01). eCRS was predicted at eosinophil above 4.27% of total WCC (sensitivity 64.1%, specificity 88.5%, AUC 0.797; P <.01; positive predictive value 89.2%, negative predictive value 62.4%, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion: eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27% of total WCC), and lower ESR when compared with non-eCRS.

AB - Background: Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective: The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods: A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results: 345 patients (48.1% female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7%) identified as eCRS, 41% with asthma and 47% CRS with nasal polyps. eCRS patients were more likely to have asthma (P <.01) and nasal polyps (P <.01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P <.01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P <.01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P =.03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9%, specificity 78.4%, area under the curve [AUC]: 0.792, P <.01). eCRS was predicted at eosinophil above 4.27% of total WCC (sensitivity 64.1%, specificity 88.5%, AUC 0.797; P <.01; positive predictive value 89.2%, negative predictive value 62.4%, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion: eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27% of total WCC), and lower ESR when compared with non-eCRS.

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KW - chronic rhinosinusitis

KW - cross-sectional studies

KW - diagnosis

KW - eosinophilic chronic rhinosinusitis

KW - eosinophils

KW - human

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