Clinical Features And The Value Of Preoperative Predictive Indexes Of Eosinophilic Chronic Rhinosinusitis

Objective Eosinophilic chronic rhinosinusitis（eCRS）is the main type of Type 2endotype chronic rhinosinusitis.The incidence of eCRS is gradually increasing all over the world.Eosinophilic chronic rhinosinusitis is the focus of chronic rhinosinusitis because it is easy to relapse and easily develop into refractory sinusitis.Non-eosinophilic chronic rhinosinusitis（non-eCRS）fits in non-Type 2endotype chronic rhinosinusitis.Due to the high recurrence of eCRS,the surgical method currently was prone to be more thorough sinus opening and mucosal resection.However,the invasiveness of preoperative pathological diagnosis of eCRS prevents this method from being widely used in clinical practice.Therefore,it will be of great significance to find a more reliable and simple preoperative eCRS prediction method.Currently,peripheral blood eosinophils（EOS）are often used as an important marker of eCRS in clinical practice,and clinical scoring based on the number of peripheral blood eosinophils combined with CT score has also begun to be used in clinical research.This study intends to analyze the differences between clinical characteristics and preoperative examinations of eCRS and non-eCRS,and to understand the diagnostic value of the JESREC scale for eCRS.At the same time,I also want to understand the impact of clinical characteristics on the prognosis of CRS,so as to explore the etiology,pathogenesis,prognostic factors of eCRS,and the clinical value of preoperative predictive indicators.Method This study retrospectively included a total of 341 patients in the Department of Otorhinolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Hainan Medical University who were treated with FESS surgery and were pathologically diagnosed as CRS after surgery from January 1,2017 to December 30,2019.The diagnostic criteria refer to the European position paper on rhinosinusitis and nasal polyps in 2020,but fungal rhinosinusitis and allergic fungal rhinosinusitis need to be excluded.In each high-power field（HPF;magnification×400）,the number of EOS with infiltration of the sinus mucosa tissue≥10 was included in the eCRS group.The remaining patients who met the diagnosis of non-eCRS were included in the non-eCRS group.Analyze the results with SPSS software.Results（1）A univariate analysis comparing the indicators of the eCRS group and the non-eCRS group was carried out.The results indicated that the P<0.05（EOS%,NE%,LY%,Lund-Mac Kay CT score of the sinuses,bilateral lesions,nasal polyps,and ethmoid sinus-based lesions）.The difference is statistically significant.The P values of age,gender,smoking history,whether it is combined with AR,allergen positive,and Lund-Kennedy endoscopy score are all>0.05,and the difference is not statistically significant;（2）These factors which are the meaningful factors in the previous study enter the binary Logistic regression model analysis,and the results showed that the peripheral blood Eosinophils ratio,bilateral lesions,and ethmoid sinus lesions was significantly different between the eCRS group and the non-eCRS group（P<0.01）.There was no difference between the two groups in asthma,the peripheral blood neutrophil ratio,the peripheral blood lymphocyte ratio,Lund-Mac Kay CT scan score,and nasal polyps（P>0.05）;（3）The correlation analysis results of independent risk factors and eCRS showed that the peripheral blood Eosinophils ratio,bilateral lesions,and ethmoid sinus-based lesions was higher（P<0.01）.（4）Compared with the unilateral lesion group,univariate analysis found that EOS%,Lund-Kennedey endoscopy score,Lund-Mackay CT score,nasal polyps,ethmoid sinus-based lesions,and N_EOSwere significantly increased in the bilateral lesion group（P<0.05）.There were no significant differences in age,gender,smoking history,AR,asthma,NE%,LY%,and allergen-positive indicators between the two groups（P>0.05）.Multivariate analysis showed that only the Lund-Mackay sinus CT score was correlated with the bilateral lesion group（P<0.01）,and there was no statistical difference in other indicators.（5）Compared with the group without nasal polyps,the Lund-Kennedey endoscopy score,Lund-Mackay CT scan score,NE%,LY%,ethmoid sinus-based lesions and N_EOSwere all increased in the group with nasal polyps（P<0.05）,and there was no statistical difference in other indicators.Multivariate analysis showed Lund-Kennedey endoscopy score,Lund-Mackay CT scores,and ethmoid sinus-based lesions are significantly different between the group of with nasal polyps and without nasal polyps（P<0.01）.（6）The JESREC scale prediction method is generally consistent with the pathological diagnosis method（Kappa=0.686,P<0.01）.The difference between the diagnostic method of the JESREC scale and the pathological gold standard was statistically significant（P<0.05）.（7）The ROC curve result of JESREC score showed that the AUC is 0.867,（P<0.01）.The sensitivity and specificity of diagnosis for eCRS were respectively0.771 and 0.928,and the 95%CI was 0.827-0.907.（8）The clinical control of CRS is related to unilateral and bilateral lesions,ethmoid sinus-based lesions,and EOS%（P<0.05）.In addition,the JESREC scale can predict poor prognosis of CRS（P<0.01）.Conclusions（1）eCRS is prone to be associated with asthma,and the EOS%,NE%,LY%,and CT scores are higher than non-eCRS.The eCRS group most of which is accompanied by nasal polyps has more bilateral lesions,and ethmoid sinus lesions are heavier than maxillary sinus lesions.（2）EOS%,bilateral lesions and ethmoid sinus lesions are independent risk factor of eCRS.（3）Compared with unilateral lesion group,EOS%,Lund-Kennedey endoscopy score,Lund-Mackay CT score,nasal polyps and ethmoid sinus-based lesions were higher in the bilateral lesion group.（4）Lund-Kennedey endoscopy score,Lund-Mackay CT score,NE%,LY%,ethmoid sinus-based lesions and N_EOSwere increased in the group with nasal polyps,and Lund-Kennedey endoscopy score,Lund-Mackay CT score and ethmoid sinus-based lesions may be independent risk factors for the occurrence of nasal polyps.（5）EOS%,CT score,and JESREC scale are all valuable in diagnosing eCRS,but JESREC scale has the highest diagnostic value,sensitivity and specificity.（6）The postoperative clinical control of eCRS is related to bilateral lesions and ethmoid sinus.The main disease is related to EOS%,and the JESREC scale can predict poor prognosis after CRS.