Work

Non-invasive prediction of olfactory recovery in severe CRSwNP: a cross-compartment translational nomogram based on secretory IL-17A

Year: 2026

Type: article

Abstract: Background Predicting olfactory recovery after surgery for severe chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging. To overcome the reliance on invasive tissue biopsies, this study aimed to identify non-invasive liquid biopsy biomarkers reflecting the deep mucosal inflammatory microenvironment, ultimately developing a point-of-care prognostic model. Methods A “tissue-to-secretion” dual-cohort validation strategy was employed. A Random Forest (RF) algorithm screened deep-tissue proteomes (Luminex) in a discovery cohort ( N = 67). An independent RF model evaluated non-invasive nasal secretions (Olink) in a validation cohort ( N = 62). Bidirectionally convergent targets were assessed for continuous dose-response relationships with absolute olfactory improvement [ Δ (visual analog scale)VAS] score at 6 months. A clinical-molecular nomogram was developed and internally validated using 1,000 bootstrap resamples. Results The tissue-based RF identified interleukin (IL)-17A as a core prognostic candidate. The independent secretion-based RF model also prioritized secretory IL-17A, achieving bidirectional convergence. While canonical Type 2 cytokines (IL-5, IL-13) lost predictive significance in secretions ( P > 0.05), secretory IL-17A demonstrated a robust dose-response correlation (r = 0.334, P = 0.0003) and emerged as an independent protective factor for olfactory recovery ([odds ratio] OR = 1.408, 95% [confidence interval] CI: 1.03–2.03). The joint nomogram, seamlessly integrating baseline VAS and secretory IL-17A, yielded an optimism-corrected (area under the receiver operating characteristic curve) AUC of 0.793 (95% CI: [0.6908–0.9079]) with adequate calibration and substantial net clinical benefit. Conclusions Through cross-compartment translation, we identified secretory IL-17A as a robust, non-invasive indicator of mucosal plasticity and olfactory reversibility. The derived joint nomogram provides an actionable framework for personalized pre-operative counseling and risk stratification in severe CRSwNP.

Source: Frontiers in Allergy

DOI: 10.3389/falgy.2026.1978136