Association Between Serum Amyloid A Expression and Disease Control after Endoscopic Sinus Surgery in Patients With Chronic Rhinosinusitis With Nasal Polyps

Abstract

Objective Our previous study revealed that serum amyloid A (SAA) levels in polyp tissues could serve as a biomarker for the prediction of corticosteroid insensitivity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, their association with disease control status in the patients after endoscopic sinus surgery remains to be assessed. Methods Polyp tissues and control uncinate process mucosa were collected from 48 patients with CRSwNP and 10 healthy control subjects. SAA expression was examined using immunohistochemistry and enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curves were performed to determine the predictive value of SAA in nasal polyps. The clinical characteristics of 2 CRSwNP subtypes (SAAhigh and SAAlow) were evaluated. Results The SAA expression levels in polyp tissues were significantly elevated both in non-eosinophilic and eosinophilic CRSwNP as compared to the healthy controls. In patients with CRSwNP, the tissue SAA level was significantly higher in the disease-controlled patients than those of the partly controlled and uncontrolled. ROC curve analysis revealed that a cut-off value of 114.9 ng/mL for the tissue SAA level predicted the patients with disease-controlled status with 93.33% sensitivity and 63.64% specificity (AUC = .8727, P < .001). Furthermore, The SAAhigh subgroup showed higher tissue eosinophil numbers and percentage of the disease-controlled patients compared to the SAAlow subgroup. Conclusions Our findings suggest that measurements of SAA in polyp tissues may provide useful information for evaluating CRSwNP conditions, especially identifying the CRSwNP patients with disease-controlled status after endoscopic sinus surgery.

Relationship between Eosinophilic and Neutrophilic Inflammation in Chinese Chronic Rhinosinusitis with Nasal Polyps

“…Based on the data of the current study, it is reasonable to assume that tissue neutrophils might have a protective role in favoring disease control in CRSwNP patients. Indeed, in our another study, we have shown that tissue serum amyloid A, a marker for neutrophilic inflammation, levels are associated with a better prognosis in patients with CRSwNP after surgery [36]. Further studies with large prospective cohorts are warranted to address these issues.…”

Current understanding of disease control and its application in patients with chronic rhinosinusitis

“…Furthermore, Van der Veen et al (2017) found that the levels of control measured by EPOS2012 corresponded to mean total SNOT-22 and short form (36) health survey (SF-36) scores (p < 0.05). Lu et al (2021) found that increased serum amyloid A (SAA) level was associated with better disease control as measured by EPOS2012 criteria in patients with CRSwNP after ESS.…”

“…Five studies identified poor disease control in patients with CRS based on EPOS2012, and risk factors included tissue or blood eosinophilia, high CT score, bilateral disease, asthma, and allergic rhinitis. Furthermore, tissue eosinophil ratio >0.206, blood eosinophil ratio >0.025, Lund-Mackay score≥ 15, CT ethmoid score≥maxillary score, female gender, aspirin intolerance, and revision Functional endoscopic sinus surgery (FESS), low serum amyloid A (SAA) were independently associated with the poor disease control ( Van der Veen et al, 2017;Tao et al, 2018;Lu et al, 2021). Additionally, Wang et al (2019) found that concordant blood and tissue eosinophilia can predict poor control better than isolated blood or tissue eosinophilia.…”

“…These tools classified the patients with CRS into five (Not at all, a little, somewhat, very, and completely) control levels ( Gray et al., 2017a ; Campbell et al., 2018 ; Sedaghat et al., 2018 ; McCann et al., 2021 ; Phillips et al., 2021 ). Moreover, several recent studies have explored the predictors of poor disease control, which help to guide for escalation of the CRS treatment regimen ( Van der Veen et al., 2017 ; Tao et al., 2018 ; Wang et al., 2019 ; Lu et al., 2021 ; Penttilä et al., 2021 ; Jiang et al., 2022 ). However, these studies utilized varied components of CRS disease control assessments.…”