Predictive and Diagnostic Value of Nasal Nitric Oxide in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

Abstract

<b><i>Background:</i></b> A hallmark of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is mucosal eosinophil-predominant inflammation. Nasal nitric oxide (nNO) is a known biomarker of eosinophilic inflammation in the upper airway. However, the utility of nNO measurement in the upper airway remains controversial. The present study aimed to compare the use of other clinical parameters with nNO to prediagnose patients with eCRSwNP from Central China. <b><i>Methods:</i></b> From June 2019 to December 2019, 70 patients with CRSwNP undergoing endoscopic sinus surgery and 30 healthy subjects were enrolled. nNO measurements were performed in all of these subjects. Computed tomography scans, full blood count with differential analysis, and determination of total immunoglobulin E (total IgE) and plasma cytokines were performed before surgery. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive potential of the clinical parameters. <b><i>Results:</i></b> We recruited 24 patients with eCRSwNP and 46 with noneosinophilic CRSwNP (non-eCRSwNP). In patients with eCRSwNP, nNO levels were significantly higher than those in patients with non-eCRSwNP (<i>p</i> < 0.0001). Blood eosinophil percentages and counts, total IgE, and CT-derived ethmoid sinus and maxillary sinus ratio (E/M ratio) were all significantly higher compared with those in patients with non-eCRSwNP (<i>p</i> < 0.05). To diagnose eCRSwNP, the highest area under the curve (0.803) was determined for nNO. At a cutoff of >329 parts per billion (ppb), the sensitivity was 83.30% and the specificity was 71.70%. However, the levels of plasma cytokines Th1/Th2 were not significantly different between the histological types of CRSwNP (<i>p</i> > 0.05). <b><i>Conclusion:</i></b> Measurement of nNO is useful for the early diagnosis of eCRSwNP.

Predictive Value of Nasal Nitric Oxide and Serum NOS2 Levels in the Efficacy of Subcutaneous Immunotherapy in Pediatric Patients with Allergic Rhinitis

“…Prior publications demonstrated that nNO could be used as a reproducible and noninvasive biomarker in respiratory diseases [ 36 , 37 ]. Lv et al's study discovered that the measurement of nNO was useful for the early diagnosis of eosinophilic CRS with nasal polyps [ 38 ]. Our study indicated that the levels of both nNO and serum NOS2 were significantly higher in AR patients in comparison with the HCs, which was consistent with previous studies [ 39 ].…”

Clinical and Laboratory Features of Various Criteria of Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

“…We abstracted data on numbers of patients, sex, nationality, diagnostic criteria, outcomes of additional tests performed to evaluate ECRS, and the P -values for comparisons of ECRS and non-ECRS. Analyzed outcomes were the percentage or absolute count of eosinophils [ 3 - 5 , 9 - 51 ], total non-specific immunoglobulin E (IgE) [ 3 , 4 , 13 , 15 , 16 , 19 , 21 - 23 , 30 , 35 , 39 - 41 , 48 , 52 - 54 ], endoscopic polyp score [ 3 , 9 , 28 - 30 , 32 , 33 , 37 , 38 , 40 , 41 , 43 , 51 , 52 , 54 - 59 ], nasal symptomatic score [ 3 , 31 , 33 , 37 , 40 , 41 , 46 , 50 - 52 , 55 - 58 , 60 ], olfactory function [ 23 , 25 - 27 , 30 , 37 , 41 ,…”

“…We abstracted data on numbers of patients, sex, nationality, diagnostic criteria, outcomes of additional tests performed to evaluate ECRS, and the P-values for comparisons of ECRS and non-ECRS. Analyzed outcomes were the percentage or absolute count of eosinophils [3][4][5], total non-specific immunoglobulin E (IgE) [3,4,13,15,16,19,[21][22][23]30,35,[39][40][41]48,[52][53][54], endoscopic polyp score [3,9,[28][29][30]32,33,37,38,40,41,43,51,52,[54][55][56][57][58][59], nasal symptomatic score [3,31,33,37,40,41,46,[50]…”

“…H T S [25,34,35,38,39,41,[43][44][45][46][47]50,51,61]. The risk of bias (methodological quality) was assessed using the Newcastle-Ottawa scale.…”

Comment on: Predictive and Diagnostic Value of Nasal Nitric Oxide in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

“…Dear Editor, I was interested to read the article authored by Lv et al [1] published in Int Arch Allergy Immunol. The authors aimed to compare the use of clinical parameters with nasal nitric oxide (nNO) to prediagnose patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) from Central China.…”