Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis : A Real-World Study

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Virkkula , P , Penttilä , E , Vento , S I , Myller , J , Koskinen , A , Hammaren-Malmi , S , Laulajainen-Hongisto , A , Hytönen , M , Lilja , M , Numminen , J , Sillanpää , S , Sahlman , J & Toppila-Salmi , S 2020 , ' Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis : A Real-World Study ' , Allergy & rhinology (Providence, R.I.) , vol. 11 , 2152656720956596 . https://doi.org/10.1177/2152656720956596

Title: Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis : A Real-World Study
Author: Virkkula, P.; Penttilä, E.; Vento, S. I.; Myller, J.; Koskinen, A.; Hammaren-Malmi, S.; Laulajainen-Hongisto, A.; Hytönen, M.; Lilja, M.; Numminen, J.; Sillanpää, S.; Sahlman, J.; Toppila-Salmi, S.
Contributor: University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HYKS erva
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Head and Neck Center
University of Helsinki, HUS Inflammation Center
Date: 2020-10
Language: eng
Number of pages: 7
Belongs to series: Allergy & rhinology (Providence, R.I.)
ISSN: 2152-6567
URI: http://hdl.handle.net/10138/321628
Abstract: Background: Developing tools to identify chronic rhinosinusitis with nasal polyps (CRSwNP) patients requiring surgical treatment would help clinicians treat patients more effectively. The aim of this retrospective cross-sectional study was to identify cut-off values for eosinophil percentage, nasal polyps (NP), and Lund-Mackay (LM) scores that may predict the need for surgical treatment in Finnish CRSwNP patients. Methods: Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001-19 were used. Data was collected from patient records and Lund-Mackay scores were determined from sinus computed tomography scans. The percentage of eosinophils was microscopically evaluated from the polyp samples available (n = 81). Associations were analyzed by Mann Whitney U test, and cut-off values by the area under the receiver operating characteristic curve (AUROC). Results: ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was associated significantly with ESS (p = 0.001), whereas peripheral blood eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05). AUROC values (95% CI) for detecting those needing ESS were for polyp eosinophilia 0.71 (0.60-0.83), p = 0.001, for LM score 0.59 (0.50-0.67), p = 0.054; for NP score 0.56 (0.48-0.64), p = 0.17, and for blood eosinophil count 0.68 (0.46-0.90), p = 0.08. With the threshold value of polyp eosinophilia (>25%), the sensitivity and specificity were optimal for detecting the group needing ESS from the group not undergoing ESS. The cut-off value of blood eosinophil count (>0.26 x 10(9)/L) had relatively good, yet statistically insignificant (underpowered), predictive potential. Moderate cut-off values were found for endoscopic LM score (>= 14/24) and NP score (>= 4/8). Conclusions: Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level CRSwNP patients. A future challenge would be to find less invasive and cost-effective clinical factors predicting uncontrolled CRSwNP.
Subject: chronic rhinosinusitis
computed tomography
nasal polyp
sinusitis
ENDOSCOPIC SINUS SURGERY
LONG-TERM OUTCOMES
CHRONIC RHINOSINUSITIS
REVISION RATES
RECURRENCE
ASTHMA
HYPERSENSITIVITY
PREVALENCE
ASPIRIN
ALLERGY
3125 Otorhinolaryngology, ophthalmology
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