Evaluation of Incidence and Prognosis of COVID-19 in Patients with Nasal Polyps

Abstract

Objective: Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Type 2 immune response accompanied by type 2 cytokines such as IL-4, IL-5, IL-13, and eosinophilic inflammation, may have a potential protective effect against COVID-19 in chronic rhinosinusitis patients with nasal polyps (CRS + P). In the study, it was aimed to investigation the prevalence and prognosis of COVID-19 in chronic rhinosinusitis patients with nasal polyps (CRS + P).

Materials and Methods: Patients between the ages of 15-65 operated for CRS + P and were compared with the control group in terms of incidence and disease severity.

Results: Covid RT-PCR test was positive in 5.04% of CRS + P patients. This rate was 8.96% in the control group, and the difference between both groups was statistically significant. When the two groups were compared in terms of disease severity, no significant difference was found.

Conclusions: The incidence of COVID-19 was lower in patients with CRS + P. However, further prospective studies are needed to research the relationship between nasal polyp and COVID-19.

Keywords

• COVID-19
• cytokines
• eosinophilic
• incidence
• nasal polyp

Nazal Polipli Hastalarda COVID-19 İnsidansının ve Prognozunun Değerlendirilmesi

Öz

Amaç: Koronavirüs hastalığı 2019 (COVID-19), şiddetli akut solunum sendromu koronavirüs-2'nin (SARS-CoV-2) neden olduğu küresel bir pandemik bulaşıcı hastalıktır. IL-4, IL-5, IL-13 gibi tip 2 sitokinlerin ve eozionifililik enflamasyonun eşlik ettiği tip 2 immün yanıt nazal polipli kronik rinosinüzit (KRS+P) hastalarında COVID-19’a karşı potansiyel koruyucu etkisi olabilir. Bu çalışmada nazal polipli kronik rinosinüzit (KRS+P) hastalarında COVİD-19 sıklığı ve prognozu belirlemek amaçlandı.

Materyal ve Metot: KRS+P nedeniyle ameliyat edilen 15-65 yaş arası hastalar, insidans ve hastalık şiddeti açısından kontrol grubu ile karşılaştırıldı.

Bulgular: KRS+P hastalarının %5,04'ünde Covid RT-PCR testi pozitif çıktı. Kontrol grubunda bu oran %8,96 idi ve her iki grup arasındaki fark istatistiksel olarak anlamlıydı. İki grup hastalık şiddeti açısından karşılaştırıldığında anlamlı bir fark bulunmadı.

Sonuç: KRS+P hastalarında COVID-19 insidansı daha düşüktü. Ancak nazal polip ile COVID-19 arasındaki ilişkiyi araştırmak için daha ileri prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• COVID-19
• eozinofilik
• insidans
• nazal polip
• sitokinler

Kaynakça

1. Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. doi:10.4193/Rhin20.600
2. Akdis CA, Bachert C, Cingi C, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2013;131(6):1479-90. doi:10.1016/j.jaci.2013.02.036
3. Van Bruaene N, Pérez-Novo CA, Basinski TM, et al. T-cell regulation in chronic paranasal sinus disease. J Allergy Clin Immunol. 2008;121(6):1435-41. doi:10.1016/j.jaci.2008.02.018
4. Wang C, Zhang L. Use of biologics in chronic sinusitis with nasal polyps. Curr Opin Allergy Clin Immunol. 2019;19(4):365-372. doi:10.1097/ACI.0000000000000540
5. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017
6. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032
7. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-118. doi:10.1016/j.jaci.2020.04.006
8. Dong X, Cao YY, Lu XX, et al. Eleven faces of coronavirus disease 2019. Allergy. 2020;75(7):1699-1709. doi:10.1111/all.14289

9. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. doi:10.1111/all.14238
10. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052
11. Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science. 2020;367(6485):1444-1448. doi:10.1126/science.abb2762
12. Saheb Sharif-Askari N, Saheb Sharif-Askari F, Alabed M, et al. Airways expression of SARS-CoV-2 receptor, ACE2, and TMPRSS2 is lower in children than adults and increases with smoking and COPD. Mol Ther Methods Clin Dev. 2020;18:1-6. doi:10.1016/j.omtm.2020.05.013
13. Saheb Sharif-Askari F, Saheb Sharif-Askari N, Goel S, et al. Are patients with chronic rhinosinusitis with nasal polyps at a decreased risk of COVID-19 infection? Int Forum Allergy Rhinol. 2020;10(10):1182-1185. doi:10.1002/alr.22672
14. Dembic Z. The cytokines of the immune system: the role of cytokines in disease related to immune response: Academic Press; 2015.
15. Levings MK, Schrader JW. IL-4 inhibits the production of TNF-alpha and IL-12 by STAT6-dependent and -independent mechanisms. J Immunol. 1999;162(9):5224-9.
16. Velde AA, Huijbens RJ, Heije K, de Vries JE, Figdor CG. Interleukin-4 (IL-4) inhibits secretion of IL-1 beta, tumor necrosis factor alpha, and IL-6 by human monocytes. Blood. 1990;76(7):1392-7.
17. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407-4416. doi:10.1007/s00330-020-06817-6
18. Wang M, Wang C, Zhang L. Inflammatory endotypes of CRSwNP and responses to COVID-19. Curr Opin Allergy Clin Immunol. 2021;21(1):8-15. doi:10.1097/ACI.0000000000000700
19. Liu S, Zhi Y, Ying S. COVID-19 and asthma: Reflection during the pandemic. Clin Rev Allergy Immunol. 2020;59(1):78-88. doi:10.1007/s12016-020-08797-3
20. Wang C, Lou H, Wang X, et al. Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2015;135(4):922-929.e6. doi:10.1016/j.jaci.2014.10.018
21. Wang M, Bu X, Fang G, et al. Distinct expression of SARS-CoV-2 receptor ACE2 correlates with endotypes of chronic rhinosinusitis with nasal polyps. Allergy. 2021;76(3):789-803. doi:10.1111/all.14665
22. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5