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
- 1Department of Otorhinolaryngology—Head and Neck Surgery, Anhui No. 2 Provincial People’s Hospital (Anhui Eye Hospital), Hefei, Anhui, China
- 2Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- 3Department of Otorhinolaryngology—Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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: Recurrence occurred in 124/400 participants from the development cohort and in 99/320 participants from the held-out cohort. Each doubling of SIRI had been associated with the disease recurrence after adjustment [odds ratio, 1.47; 95% confidence interval (CI), 1.06–2.04; P = 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.
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BibTeX
@article{qian2026preoperative,
title = {{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}},
author = {Xudong Qian and Shanshan Tong and Pingcun Wei and Fan Wu},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1983990},
url = {https://doi.org/10.3389/fmed.2026.1983990},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Xudong Qian
AU - Shanshan Tong
AU - Pingcun Wei
AU - Fan Wu
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1983990
UR - https://doi.org/10.3389/fmed.2026.1983990
AB - 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: Recurrence occurred in 124/400 participants from the development cohort and in 99/320 participants from the held-out cohort. Each doubling of SIRI had been associated with the disease recurrence after adjustment [odds ratio, 1.47; 95% confidence interval (CI), 1.06–2.04; P = 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.
SN - 2296-858X
ER -