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Preoperative systemic inflammation response index and 12-month endoscopic recurrence after endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: association and incremental predictive performance in a same-institution, two-campus cohort

Year: 2026

Type: article

Abstract: Background: The systemic inflammation response index (SIRI) is a readily obtainable marker derived from routine blood count analyses and has been associated with the recurrence of chronic rhinosinusitis with nasal polyps. Whether it provides added prognostic information beyond routine clinical predictors remains uncertain. Methods: This retrospective, single-institution, two-campus study included 805 participants who were at least 18 years of age (with no upper age limit) and who underwent a endoscopic sinus surgery (ESS). The Main Campus development cohort included 445 participants, and the Huangshan Road Campus held-out cohort included 360 participants; 400 and 320 participants from both cohorts, respectively, had evaluable 12-month outcomes. Aspirin-exacerbated respiratory disease (AERD) was clinically ascertained separately from general hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). Clinical and extended logistic models were compared using discrimination, calibration, Brier's score, and paired bootstrap estimates of incremental performance. Sensitivity analyses used stabilized inverse-probability weighting, 200 outcome imputations, and two extreme-outcome assignments and excluded NSAID-hypersensitive participants without AERD. Results: = 0.022]. Adding SIRI changed the area under the receiver operating characteristic curve by 0.007 in the evaluation of the development cohort (bootstrap 95% CI, -0.002 to 0.026) and by 0.010 in the evaluation of the held-out cohort (-0.016 to 0.030); corresponding improvements in Brier's score were 0.0036 (0.00006-0.0108) and 0.0044 (-0.0025 to 0.0111). Eighty-five participants lacked an evaluable outcome. The SIRI odds ratios were 1.46 with weighting, 1.47 with imputation, and 1.46 after the AERD sensitivity exclusion. Assuming that every missing outcome was recurrence attenuated the estimate to 1.31 (0.99-1.74). Conclusions: The preoperative SIRI was associated with 12-month endoscopic recurrence after ESS. This association was broadly preserved in inverse probability-weighted, multiple-imputation, and AERD-restricted analyses, although it was attenuated when all missing outcomes were assigned to recurrence. The SIRI-only model showed moderate discrimination as a simple and readily available marker of systemic inflammation, but its incremental predictive gain beyond routine clinical predictors was modest and uncertain. Therefore, these findings support SIRI as a candidate prognostic marker for prospective external validation rather than as a tool for immediate treatment or surveillance decisions.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1983990

Authors: Xudong Qian, Shanshan Tong, Pingcun Wei, Fan Wu

Institutions: Macau University of Science and Technology, First Affiliated Hospital of Anhui Medical University

Language: English

Topic: Sinusitis and nasal conditions

Subfield: Otorhinolaryngology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801