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. 2016 Aug;13(8):1253-61.
doi: 10.1513/AnnalsATS.201511-742OC.

Blood Eosinophils and World Trade Center Exposure Predict Surgery in Chronic Rhinosinusitis. A 13.5-Year Longitudinal Study

Sophia Kwon  1 , Barbara Putman  2 , Jessica Weakley  3 , Charles B Hall  4 , Rachel Zeig-Owens  5   3 , Theresa Schwartz  3 , Brianne Olivieri  3 , Ankura Singh  3 , Maryann Huie  6 , Debra Morrison  6 , Mayris P Webber  5   4 , Hillel W Cohen  5 , Kerry J Kelly  5 , Thomas K Aldrich  3 , Anna Nolan  1   5 , David J Prezant  5   3 , Michael R Shohet  7 , Michael D Weiden  1   5
Affiliations

Blood Eosinophils and World Trade Center Exposure Predict Surgery in Chronic Rhinosinusitis. A 13.5-Year Longitudinal Study

Sophia Kwon et al. Ann Am Thorac Soc. 2016 Aug.

Abstract

Rationale: The World Trade Center (WTC) collapse generated caustic airborne particulates that caused chronic rhinosinusitis in exposed Fire Department of New York firefighters. Surgery was performed when symptoms remained uncontrolled despite medical management.

Objectives: To identify predictors of surgical intervention for chronic rhinosinusitis in firefighters exposed to airborne irritants at the WTC collapse site.

Methods: We assessed in 8,227 firefighters with WTC exposure between September 11, 2001 (9/11), and September 25, 2001, including WTC-site arrival time, months of rescue and recovery work, and eosinophil concentration measured between 9/11 and March 10, 2003. We assessed the association of serum cytokines and immunoglobulins with eosinophil concentration and surgery for rhinosinusitis in 112 surgical cases and 376 control subjects with serum available from the first 6 months after exposure to the WTC collapse site.

Measurements and main results: Between 9/11 and March 10, 2015, the surgery rate was 0.47 cases per 100 person-years. In the first 18 months post-9/11, surgical patients had higher mean blood eosinophil levels than study cohort patients (219 ± 155 vs. 191 ± 134; P < 0.0001). Increased surgery risk was associated with increasing blood eosinophil counts (hazard ratio [HR], 1.12 per 100 cells/μl; 95% confidence interval [CI], 1.07-1.17; P < 0.001); arriving at the WTC site on 9/11 or September 12, 2001 (HR, 1.43; 95% CI, 1.04-1.99; P = 0.03); and working 6 months or longer at the WTC site (HR, 1.48; 95% CI, 1.14-1.93; P < 0.01). Median blood eosinophil levels for surgical patients were above levels for the cohort in all 18-month intervals March 11, 2000, through March 10, 2015, using 51,163 measurements representing 97,733 person-years of observation. Increasing age, increasing IL-17A, and low IgA in serum from 2001 to 2002 predicted blood eosinophil concentration in surgical patients but not in control subjects (R(2) = 0.26, P < 0.0001; vs. R(2) = 0.008, P = 0.56).

Conclusions: Increasing blood eosinophil concentration predicts surgical intervention for chronic rhinosinusitis, particularly in those with intense acute and prolonged exposure to airborne irritants. WTC-exposed Fire Department of New York firefighters who underwent irritant-associated sinus surgery are immunologically different from the cohort. Surgical patients have a higher blood eosinophil levels that is associated with mediators of mucosal immunity.

Keywords: cohort studies; eosinophils; otolaryngology surgery; particulate matter; sinusitis.

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Figures

Figure 1.
Figure 1.
Study population of firefighters who participated in the World Trade Center (WTC) study. Shown are the number of male firefighters who were employed by the Fire Department of New York City on September 11, 2001, who were present at the WTC between September 11 and September 24, 2001 and are included in the study group; the number who had physician-diagnosed chronic rhinosinusitis (CRS); and the number who underwent sinus surgery between September 11, 2001, and March 10, 2015.
Figure 2.
Figure 2.
Cumulative incidence of surgical chronic rhinosinusitis (surgical-CRS) cases from September 11, 2001, to March 10, 2015, in firefighters who worked at the World Trade Center (WTC) site during the first 2 weeks after 9/11 by blood eosinophil (Eos) concentration (A), WTC-site arrival time (B) and WTC-site work duration (C). (A) The cumulative incidence of surgical-CRS cases after the cohort was stratified by blood eosinophil concentration above and below 240 cells per microliter, the top quartile in the 18 months post-9/11. (B) The cumulative incidence of surgical-CRS cases after the cohort was stratified by initial WTC-site arrival time, either within the first 2 days of 9/11 or after September 12, 2001. (C) The cumulative incidence of surgical-CRS cases after the cohort was stratified by months of WTC rescue and recovery work: 1 month, 2–5 months, and 6 or more months.
Figure 3.
Figure 3.
Blood eosinophil concentration in firefighters who worked at the World Trade Center site during the first 2 weeks after 9/11 according to surgical chronic rhinosinusitis (surgical-CRS) status. Shown are the median eosinophil concentrations from March 10, 2000, to March 10, 2015, in 18-month intervals. The blue dots show data for Fire Department of New York City firefighters who worked at the World Trade Center site during the first 2 weeks after the attack of September 11, 2001, and who had eosinophil measurements between September 11, 2001, and March 10, 2003. The red triangles show data from the group that had surgical-CRS by the end of the study. The number of measurements contributing to the values in each interval are shown below each data point. The top row of values show in red represents the number of eosinophil measurements in the surgical-CRS group. The bottom row of values show in blue represents the number of eosinophil measurements in the study cohort.
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