Background. Identifying specific endotypes within the broad picture of chronic rhinosinusitis with nasal polyps (CRSwNP), using biomarkers for instance, remains a challenge. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR) as potential markers of inflammation has already been discussed. Objective. The aim of the present study was to compare NLR and ELR before and after endoscopic sinus surgery (ESS) and nasal mometasone furoate for CRSwNP, stratifying patients by their clinical and histological features. Methods. The study concerned 115 consecutive patients with CRSwNP treated with ESS and nasal mometasone furoate with a postoperative follow-up beyond 12 months. Eosinophilic-type CRSwNP was histopathologically defined after hematoxylin-eosin tissue staining. Results. In the sub-cohort of patients with histological diagnosis of eosinophilic-type CRSwNP, the mean ELR significantly decreased postoperatively (0.22±0.16 vs 0.18±0.12; p=0.04), while among patients with histological diagnosis of non-eosinophilic-type CRSwNP, the mean NLR significantly decreased after surgery (1.98±0.98 vs 1.90±0.90, p=0.04). Conclusion. Different CRSwNP endotypes are characterized by different biohumoral patterns. It is reasonable to assume that surgery enables clearance of the polyps and polypoid mucosa reducing the load of antigens triggering the inflammation. Consistently with the above-mentioned biological mechanism, ESS could correspond to a reduction in blood ELR and eosinophil count in eosinophilic-type CRSwNP. The data did not demonstrate an added value of measuring pre- vs post-operative ELR compared to measuring blood eosinophil count. When used after ESS, topical corticosteroids also have more significant anti-inflammatory effects. As for the sub-cohort of patients with non-eosinophilic CRSwNP, the fact that the mean NLR dropped significantly after surgery is definitely an original finding: unlike eosinophilic inflammation, the inflammatory patterns seen in non-eosinophilic CRSwNP are still poorly understood.
Pre- and postoperative blood neutrophil- and eosinophil-to-lymphocyte ratios in patients with sinonasal polyps. A preliminary investigation.
MARIONI, GINO
2017
Abstract
Background. Identifying specific endotypes within the broad picture of chronic rhinosinusitis with nasal polyps (CRSwNP), using biomarkers for instance, remains a challenge. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR) as potential markers of inflammation has already been discussed. Objective. The aim of the present study was to compare NLR and ELR before and after endoscopic sinus surgery (ESS) and nasal mometasone furoate for CRSwNP, stratifying patients by their clinical and histological features. Methods. The study concerned 115 consecutive patients with CRSwNP treated with ESS and nasal mometasone furoate with a postoperative follow-up beyond 12 months. Eosinophilic-type CRSwNP was histopathologically defined after hematoxylin-eosin tissue staining. Results. In the sub-cohort of patients with histological diagnosis of eosinophilic-type CRSwNP, the mean ELR significantly decreased postoperatively (0.22±0.16 vs 0.18±0.12; p=0.04), while among patients with histological diagnosis of non-eosinophilic-type CRSwNP, the mean NLR significantly decreased after surgery (1.98±0.98 vs 1.90±0.90, p=0.04). Conclusion. Different CRSwNP endotypes are characterized by different biohumoral patterns. It is reasonable to assume that surgery enables clearance of the polyps and polypoid mucosa reducing the load of antigens triggering the inflammation. Consistently with the above-mentioned biological mechanism, ESS could correspond to a reduction in blood ELR and eosinophil count in eosinophilic-type CRSwNP. The data did not demonstrate an added value of measuring pre- vs post-operative ELR compared to measuring blood eosinophil count. When used after ESS, topical corticosteroids also have more significant anti-inflammatory effects. As for the sub-cohort of patients with non-eosinophilic CRSwNP, the fact that the mean NLR dropped significantly after surgery is definitely an original finding: unlike eosinophilic inflammation, the inflammatory patterns seen in non-eosinophilic CRSwNP are still poorly understood.
Pubblicazioni consigliate
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
