Prognostic and pharmacologic value of cystatin SN for chronic rhinosinusitis with nasal polyps.

ABSTRACT Background Integrated care pathways (ICPs) improve the management of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The application of ICPs requires development of endotype-based biomarkers to stratify patients. The value of cytokines and markers induced by cytokines for the management of CRSwNP is largely unknown. Objectives To determine the prognostic and pharmacologic value of type 2, non-type 2 cytokines, and markers associated with type 2 inflammation including CCL26, periostin, and cystatin SN, in nasal secretions for CRSwNP. Methods This retrospective study divided 151 patients with CRSwNP into discovery and validation phases. Concentrations of cytokines, CCL26, periostin, and cystatin SN in nasal secretions were determined using Luminex and ELISA. Predictive significance was assessed with receiver-operating characteristic curves. Survival analysis was performed using Kaplan-Meier curves and Cox regression models. Results Cystatin SN was an independent predictor of the uncontrolled status of CRSwNP over a 2-year follow-up after adjusting for other risk factors (hazard ratio [HR] of 1.168 and 1.132 in discovery and validation phases, respectively; both p Conclusion Cystatin SN levels in nasal secretions hold strong prognostic value and can facilitate medical instructions for managing CRSwNP.