Clinical Characteristics may help predict refractoriness to endoscopic sinus surgery in patients with Chronic Rhinosinusitis

Clinical characteristics of chronic rhinosinusitis (CRS) patients with persistent cytokine elevations after endoscopic sinus surgery (ESS) may identify patients who benefit from specific type 2 biologics. At 6-12 months post-ESS, middle meatus (MM) mucus secretions were obtained from CRS patients and cytokines IL-5 and Il-13 were measured using Luminex. Cytokine levels above the 90th percentile of non-CRS control mucus defined elevated cytokine status. Univariate logistic regression models identified pre- and post-ESS demographic, patient-reported, radiographic, olfactory testing, and endoscopic features associated with elevated post-ESS MM cytokine status. Multivariate logistic regression models incorporating routinely collected “clinical” features were compared to “enhanced” models using study-specific variables MM mucus from 123 CRS patients was collected 8.7 months (mean) post-ESS and 19 and 22 patients had elevated IL-5 and IL-13, respectively. Pre-ESS polyp status and radiographic severity [Modified Lund-Mackay (MLM) score]; and post-ESS MLM were all significantly associated with both elevated IL-5 and elevated IL-13 on univariate analysis. Post-ESS patient reported CRS-PRO and olfactory threshold; and post-ESS polyp size were uniquely associated with IL-5 and IL-13, respectively. In multivariate analysis, pre-ESS polyp status and post-ESS CRS-PRO scores predicted elevated IL-5 in the clinical model (AUC:0.725), whereas pre-ESS polyp status and post-ESS MLM were predictive in enhanced models (AUC:0.754). In contrast, only post-ESS polyp size identified patients with elevated IL-13 in both clinical (AUC:0.735) and enhanced models (AUC:0.770). Although patients with persistently elevated IL-5 and IL-13 shared polyp and radiographic characteristics on univariate analysis, multivariate analysis identified unique features predictive of elevation of each cytokine.