Neuropsychiatric Sequelae of Chronic Rhinosinusitis: A Retrospective Cohort Study Using a Multi-institutional Electronic Health Records Network

TL;DR

This study finds that a type of chronic sinusitis with nasal polyps is linked to lower risks of psychiatric disorders compared to the type without polyps.

Contribution

The study identifies distinct psychiatric risk profiles between two CRS subtypes using a large multi-institutional EHR network.

Findings

CRSwNP patients had significantly lower risks of suicidal ideation and suicide attempts compared to CRSsNP patients.

CRSwNP was associated with reduced risks of depression, anxiety, and other psychiatric disorders.

The absolute risk differences for psychiatric outcomes were small despite significant relative risk reductions.

Abstract

Background: Chronic rhinosinusitis (CRS), a common inflammatory disorder of the sinonasal mucosa, is associated with significant morbidity and impaired quality of life. Emerging evidence suggests a link between systemic inflammation and neuropsychiatric disorders, including depression and suicide risk. This study examines whether phenotypic differences in CRS, specifically CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP), are associated with differing psychiatric outcomes.

Objective: The objective of this study was to evaluate whether CRSwNP and CRSsNP are differentially associated with suicidality and psychiatric disorders.

Methods: A retrospective cohort analysis was conducted using the TriNetX research network. Adults diagnosed with CRSwNP or CRSsNP between 2010 and 2023 were identified via the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Propensity score matching was used to control for demographics and comorbidities, yielding two matched cohorts (n=130,769 each). Primary outcomes included suicidal ideation and suicide attempts. Secondary outcomes included depression, generalized anxiety disorder, bipolar disorder, schizophrenia, schizoaffective disorder, and psychosis. Risk differences, risk ratios, and odds ratios were calculated with 95% confidence intervals.

Results: Patients with CRSwNP demonstrated significantly lower risks of suicidal ideation (risk ratio (RR) 0.66) and suicide attempt (RR 0.63) compared to those with CRSsNP (all p<0.001). CRSwNP was also associated with lower risks of developing depression (RR 0.80), generalized anxiety disorder (RR 0.75), bipolar disorder (RR 0.72), schizophrenia (RR 0.63), schizoaffective disorder (RR 0.63), and psychosis (RR 0.64), although absolute risk differences were small.

Conclusion: CRSwNP is associated with a significantly lower risk of several psychiatric disorders compared to CRSsNP, potentially due to differences in underlying inflammatory pathways or treatment effects. These findings support the integration of psychiatric screening in CRS management and warrant further investigation into immune modulation as a potential strategy to reduce neuropsychiatric risk.

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