Correlaciones clínicas, morfológicas y de calidad de vida en pacientes afectos de rinosinusitis crónica con poliposis nasal

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INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenging dis-ease that significantly impacts patients’ quality of life (QoL). Eosinophils are considered the most important inflammatory cells in the pathogene-sis of rhinosinusitis with nasal polyposis. Being able to predict QoL in patients with CRSwNP will optimize management and improve patient outcomes. AIM To investigate the association between QoL as per Sinonasal Outcome Test -22 (SNOT-22) and histopathological and molecular parameters (including eosinophil and mucin 1 –MUC1- expression) in patients with CRSwNP. Secondary aims included the association between QoL and clinical variables as well as the role of these parameters in assessing systemic and topic steroid treatment response. METHODS Prospective and retrospective review of medical records of 62 patients treated for CRSwNP. Factors as age, sex, allergies, smoking, history of asthma, non-steroidal drugs (NSAID) intolerance, clinical and endoscopic disease severity, medical and surgical treatment, microbiology profile, tissue eosinophilia, MUC1, MKP1, MIF, GRα, IL-8, TLR2, TLR4 and TLR5 expression were recorded. QoL was assessed using the SNOT-22 questionaire and differences in QoL were compared between all the gathered parameters. Statistical analysis was performed by R Core Team (2017) and Statistic software R. RESULTS 62 patients with CRSwNP were identified. Mean SNOT-22 score was 39.8, mean eosinophil expression was 28% and mean MUC1 expression was 1.02. SNOT-22 score correlates statistically with high IL-8 levels and high eosinophil levels (p= 0.01 and 0.02 respectively). No association was established between MUC1 expression and SNOT-22 outcome. When considering eosinophilia, MUC1, asthma and NSAID intolerance, the latest shows a significant association with QoL. Patients with high eosinophil levels have better systemic steroid response (p=0.03). This association is not statistically significative when comparing MUC1 ex-pression and systemic steroid response (p=0.14). Topical corticosteroid response was associated with high MUC1 expression (p=0.02). CONCLUSION This thesis demonstrated a significant association between the role of inflammatory parameters (eosinophils and IL-8) and clinical patterns (NSAID intolerance) in QoL in patients with CRSwP.
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