Resident Physician Vanderbilt University Medical Center Nashville, Tennessee
Introduction: Inflammatory endotypes in chronic rhinosinusitis (CRS) may predict severity of disease, need for multiple sinus surgeries, and treatment response. The goal of this study was to analyze nasal mucous inflammatory cytokine patterns in CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis and their association with treatment failure and revision sinus surgery.
Methods: 198 patients with CRS who underwent sinus surgery were included. Cytokines were quantified in intraoperative mucus specimens using a multiplex flow cytometric bead assay. Patterns of cytokine expression in patients with 0, 1 and at least 2 prior sinus surgeries were analyzed using Kruskal-Wallis analysis of variance and principal component regression.
Results: There were 122 CRSwNP and 76 CRSsNP patients. The CRSwNP cohort included 70, 31, and 21 patients with 0, 1 and at least 2 prior surgeries, respectively. The CRSsNP cohort included 55, 16, and 5 patients with 0, 1 and at least 2 prior surgeries. There was a statistically significant increase in the following cytokines with increasing number of surgeries in the CRSwNP cohort: IL-2, IL-4, IL-6, IL-9, IL-17A. Revision surgery was not associated with the prototypical type 2 cytokines IL-5 and IL-13. In CRSsNP only IL-1B was significantly higher in patients with prior surgery.
Conclusion: This analysis suggests that CRSwNP patients who require revision sinus surgery have higher type 2 and 3 inflammatory cytokines. A significantly elevated type 2/3 cytokine profile may be associated with more severe disease and/or topical treatment resistance. Patients with CRSsNP requiring revision surgery do not appear to exhibit this pattern.