Risk factors for postoperative relapse of chronic rhinosinusitis with nasal polyps and improvement in clinical treatment

Objectives: To identify the risk factors for postoperative relapse of chronic rhinosinusitis with nasal polyps (CRSwNP) using multivariate Logistic regression analysis and to explore potential improvements in clinical treatment measures.

Methods: We selected 270 CRSwNP patients who underwent surgery at The First People's Hospital of Jiangxia District between January 2022 and July 2024. The patients were divided into two groups based on the presence or absence of postoperative relapse: 40 cases with relapse were designated as the relapse group, and the other 230 cases without relapse were designated as the non-relapse group. Serum samples were collected from both groups before surgery to measure eosinophilic cationic protein (ECP)/myeloperoxidase (MPO), immunoglobulin E (IgE), and C-C motif chemokine ligand 4 (CCL4). Receiver operating characteristic (ROC) curves were used to analyze the predictive value of these indices for postoperative relapse in CRSwNP patients. The correlation of these indices with postoperative relapse was analyzed using Spearman's correlation coefficients. Univariate and multivariate analyses were employed to identify factors influencing postoperative relapse of CRSwNP.

Results: The relapse group showed markedly higher ECP/MPO, IgE, and CCL4 compared to the non-relapse group. The area under the curve (AUC) for predicting postoperative relapse of CRSwNP by each single indicator approximated 0.800, while the AUC of combined detection was above 0.900. ECP/MPO, IgE, and CCL4 all exhibited a significant positive correlation with postoperative relapse of CRSwNP. Univariate analysis revealed that the postoperative relapse of CRSwNP was significantly linked to the Davos score of nasal polyps, smoking history, postoperative infection, ECP/MPO, IgE, and CCL4. Multivariate analysis confirmed that ECP/MPO, IgE, and CCL4 were independent risk factors for postoperative recurrence of CRSwNP.

Conclusions: ECP/MPO, IgE, and CCL4 are reliable predictors of postoperative relapse in CRSwNP patients, and their combined detection can further enhance the predictive accuracy. These biomarkers are closely and positively correlated with postoperative relapse and serve as risk factors for postoperative recurrence. Given the elevated risk of postoperative recurrence in CRSwNP patients with high levels of ECP/MPO, IgE, and CCL4, it is recommended to optimize clinical treatment strategies for these patients to reduce the likelihood of recurrence.