Sinus computed tomography predicts clinical response to corticosteroids in chronic rhinosinusitis with nasal polyps
Hong, H Wang, D Tan, K.S Zheng, R Chen, F Gao, W He, H Shi, J Fan, Y Yang, Q
Hong, H
Wang, D
Zheng, R
Chen, F
Gao, W
He, H
Shi, J
Fan, Y
Yang, Q
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Alternative Title
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy. However, the therapeutic response varies markedly between individuals. The objective of this study was to evaluate the diagnostic values of sinus computed tomography (CT) for GC-sensitivity in patients with CRSwNP. Methods: We conducted a prospective, single-blinded study of 47 consecutive patients with CRSwNP. These patients were given a course of oral prednisone (30 mg daily for 14 days) and subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and GC-insensitive subgroups: Lund-Mackay scores, olfactory cleft (OC) scores, and blood eosinophil counts and ratio (percentage of the total white blood cells). Results: 25/47 (53.2%) and 29/47 (61.7%) patients were objectively and subjectively sensitive to GC therapy, respectively. The OC score and the blood eosinophil counts and ratio in GC-sensitive subgroup were significantly higher than those in GC-insensitive subgroup, defined either objectively or subjectively. Multivariate logistic regression revealed that OC score was independent risk factor for objective or subjective GC-sensitivity. The OC score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (the OC score AUC = 0.775 and 0.829, respectively). A OC score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP. Conclusion: Our prospective findings validate the potential value of sinus CT scan in predicting GC-sensitivity in CRSwNP patients. © 2018 The Author(s).
Keywords
corticosteroid, prednisone, accuracy, adult, area under the curve, Article, chronic rhinosinusitis, clinical article, computer assisted tomography, drug efficacy, drug response, eosinophil count, human, image analysis, image quality, leukocyte count, male, nose polyp, predictive value, prescription, priority journal, receiver operating characteristic, risk assessment, risk factor, scoring system, sensitivity and specificity, treatment duration, treatment outcome
Source Title
Clinical and Translational Allergy
Publisher
Series/Report No.
Collections
Rights
Attribution 4.0 International
Date
2018
DOI
10.1186/s13601-018-0211-1
Type
Article