Serum Biomarkers as Predictors of Recurrence in Chronic Rhinosinusitis with Nasal Polyps

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous type 2 inflammatory disease characterized by frequent postoperative recurrence despite endoscopic sinus surgery (ESS). Reliable biomarkers capable of predicting recurrence remain insufficiently validated. This study evaluates the prognostic utility of circulating biomarkers for recurrence prediction in CRSwNP, in addition to the predictive performance of the blood eosinophilia. Materials and Methods: A prospective cohort of 69 patients with CRSwNP undergoing primary ESS was followed for up to 3 years. Periostin, eotaxin-3, procalcitonin and IL-33 were taken from blood before surgery and analyzed by ELISA technique. Clinical outcomes were assessed using SNOT-22 and Perioperative Sinus Endoscopy (POSE) scores. Statistical analyses included Spearman's correlation, the Mann-Whitney U test, the Kruskal-Wallis test, Cox proportional hazards regression, multivariable binary logistic regression, ROC analysis, and longitudinal MANCOVA. Results: Blood eosinophilia remained the strongest clinical predictor of recurrence (OR = 4.55, p = 0.001). Serum periostin, eotaxin and procalcitonin significantly correlated with postoperative disease severity and recurrence, particularly with POSE scores at 1 and 3 years (p < 0.05). Patients with recurrence demonstrated significantly higher serum levels of these biomarkers compared with controlled patients (all p < 0.001). Multivariate Cox regression identified periostin (HR = 1.033, p = 0.010), eotaxin (HR = 1.554, p < 0.001) and procalcitonin (HR = 1.183, p < 0.001) as significant predictors of recurrence. Procalcitonin demonstrated the highest predictive performance in ROC analysis (AUC = 0.805). Longitudinal MANCOVA confirmed significant associations between periostin, eotaxin, procalcitonin, and persistent postoperative inflammatory burden over 3 years. Conclusions: Circulating periostin, eotaxin and procalcitonin are promising predictors of CRSwNP recurrence and appear to contribute to prognostic accuracy. Integration of serum biomarker profiling into clinical practice may improve personalized postoperative management and risk stratification in CRSwNP.