Cluster analysis of patients with chronic rhinosinusitis and asthma after endoscopic sinus surgery

Patients with Chronic rhinosinusitis with nasal polyps and asthma (CRSwAS) are highly heterogenous in severity and prognosis. The clinical phenotypes and inflammatory endotypes of CRSwAS and the association with outcomes of endoscopic sinus surgery (ESS) have not been fully studied yet.We aimed to find out the clinical phenotypes of CRSwAS and explore their relationship with ESS outcome using cluster analysis.We recruited 103 consecutive adult CRSwAS patients who had undergone ESS and been followed up for more than one year. For cluster analysis, we collected the data of 63 variables pertaining to demographic characteristics, preoperative disease status, surgical techniques, postoperative medical treatment and outcomes. Eosinophilic CRS was defined as ≥10 eosinophils/high power field (HPF), sinus CT was evaluated by Lund-Mackay sinus CT score (LM score).We screened out 92 eligible patients and 13 preoperative variables for BIRCH cluster analysis. CRSwAS patients were divided into four clusters with distinct ESS outcomes: Cluster 1, characterized by aspirin-exacerbated respiratory disease (AERD), eosinophilic CRS, high preoperative LM score, moderate to severe asthma, uncontrolled CRS after ESS; Cluster 2, characterized by female dominant (66.67%), non-AERD, eosinophilic CRS, high preoperative LM score, moderate to severe asthma, uncontrolled CRS after ESS; Cluster 3, characterized by female dominant (95.83%), non-eosinophilic CRS, low preoperative LM score, moderate asthma, controlled CRS after ESS; Cluster 4, characterized by male only, smoker, non-eosinophilic CRS, low preoperative LM score, mild asthma, controlled CRS after ESS.CRSwAS has distinct clusters, each corresponding to unique clinical and inflammatory characteristics and ESS outcomes.