European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 5, pp 1367–1372 | Cite as

Does procalcitonin have a role in the pathogenesis of nasal polyp?

  • Suat BiliciEmail author
  • Zehra Cinar
  • Ozgur Yigit
  • Mustafa Cakir
  • Enes Yigit
  • Hafize Uzun



The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.


The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.


Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).


This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.


Nasal polyps Procalcitonin Pathogenesis Sinusitis 



We appreciate all the authors who have made efforts in the whole program, and also thank all the researchers of the primary studies. We would like to thank Ertan Koç for his contributions as all authors in this study.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ozcan C, Tamer L, Ates NA, Gorur K (2009) The glutathione-s-transferase gene polymorphisms (Gstt1, Gstm1, and Gstp1) in patients with non-allergic nasal polyposis. Eur Arch Otorhinolaryngol 267:227–232CrossRefPubMedGoogle Scholar
  2. 2.
    Zhang G, Zhang J, Kuang M, Lin P (2018) The role of TNF alpha polymorphism and expression in susceptibility to nasal polyposis. Immun Invest 47(4):360–371CrossRefGoogle Scholar
  3. 3.
    Sreeparvathı A. Kalyanikuttyamma LK, Kumar M, Sreekumar N, Veerasigamani N (2017) Significance of blood eosinophil count in patients with chronic rhinosinusitis with nasal polyposis. J Clin Diagn Res 11(2): MC08–MC11PubMedPubMedCentralGoogle Scholar
  4. 4.
    İsmi O, Özcan C, Polat G, Kul S, Gorur K, Pütürgeli T (2017) TNF-α and IL-1 β cytokine gene polymorphism in patients with nasal polyposis. Turk Arch Otorhinolaryngol 55(2):51–56CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bolger WE, Joshi AS, Spear S, Nelson M, Govindaraj K (2007) Gene expression analysis in sinonasal polyposis before and after oral corticosteroids: a preliminary investigation. Otolaryngol Head Neck Surg 137(1):27–33CrossRefPubMedGoogle Scholar
  6. 6.
    Davidsson A, Danielsen A, Viale G, Olofsson J, Dell’Orto P, Pellegrini C, Karlsson MG, Hellquist HB (1996) Positive identification in situ of mRNA expression of IL-6, and IL-12, and the chemotactic cytokine RANTES in patients with chronic sinusitis and polypoid disease. Clinical relevance and relation to allergy. Acta Otolaryngol 116(4):604–610CrossRefPubMedGoogle Scholar
  7. 7.
    Petecchia L, Serpero L, Silvestri M, Sabatini F, Scarso L, Rossi GA (2006) The histamine-induced enhanced expression of vascular cell adhesion molecule-1 by nasal polyp-derived fibroblasts is inhibited by levocetirizine. Am J Rhinol 20(5):445–449CrossRefPubMedGoogle Scholar
  8. 8.
    Marx D, Tassabehji M, Heer S, Hüttenbrink KB, Szelenyi I (2002) Modulation of TNF and GM-CSF release from dispersed human nasal polyp cells and human whole blood by inhibitors of different PDE isoenzymes and glucocorticoids. Pulm Pharmacol Ther 15(1):7–15CrossRefPubMedGoogle Scholar
  9. 9.
    Szabó K, Kiricsi Á, Révész M, Vóna I, Szabó Z, Bella Z, Polyánka H, Kadocsa E, Kemény L, Széll M, Hirschberg A (2013) The – 308 G> A SNP of TNFα is a factor predisposing to chronic rhinosinusitis associated with nasal polyposis in aspirin-sensitive Hungarian individuals: conclusions of a genetic study with multiple stratifications. Int Immunol 25(6):383–388CrossRefPubMedGoogle Scholar
  10. 10.
    Otto BA, Wenzel SE (2008) The role of cytokines in chronic rhinosinusitis with nasal polyps. Curr Opin Otolaryngol Head Neck Surg 16(3):270–274CrossRefPubMedGoogle Scholar
  11. 11.
    Soni NJ, Samson DJ, Galaydick JL, Vats V, Huang ES, Aranson N, Pitrak D (2013) Procalcitonin-guided antibiotic therapy: a systematic review and meta-analysis. J Hosp Med 8(9):530–540CrossRefPubMedGoogle Scholar
  12. 12.
    Samsudin I, Vasikaran SD (2017) Clinical utility and measurement of procalcitonin. Clin Biochem Rev 38(2):59–68PubMedPubMedCentralGoogle Scholar
  13. 13.
    Iankova I, Thompson-Leduc P, Kirson NY, Rice B, Hey J, Krause A, Schonfeld SA, DeBrase CR, Bozzette S, Schuetz P (2018) Efficacy and safety of procalcitonin guidance in patients with suspected or confirmed sepsis: a systematic review and meta-analysis. Crit Care Med ​46(5):691–698CrossRefPubMedGoogle Scholar
  14. 14.
    Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39(2):206–217CrossRefPubMedGoogle Scholar
  15. 15.
    Gilbert DN (2011) Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 52(Suppl 4):346–350CrossRefGoogle Scholar
  16. 16.
    Brunkhorst FM, Heinz U, Forycki ZF (1998) Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med 24(8):888–889CrossRefPubMedGoogle Scholar
  17. 17.
    Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79(6):1605–1608PubMedGoogle Scholar
  18. 18.
    Luyt CE, Guerin V, Combes A, Trouillet JL, Ayed SB, Bernard M, Gibert C, Chastre J (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171(1):48–53CrossRefPubMedGoogle Scholar
  19. 19.
    Figueiredo CR, Silva IDC, Weckx LLM (2008) Inflammatory genes in nasal polyposis. Curr Opin Otolaryngol Head Neck Surg 16:18–21CrossRefPubMedGoogle Scholar
  20. 20.
    Maxfield AZ, Landegger LD, Brook CD, Lehmann AE, Campbell AP, Bergmark RW, Stankovic KM, Metson R (2018) Periostin as a biomarker for nasal polyps in chronic rhinosinusitis. Otolaryngol Head Neck Surg 158(1):181–186CrossRefPubMedGoogle Scholar
  21. 21.
    Matsusaka M, Kabata H, Fukunaga K, Suzuki Y, Masaki K, Mochimaru T et al (2015) Phenotype of asthma related with high serum periostin levels. Allergol Int 64:175–180CrossRefPubMedGoogle Scholar
  22. 22.
    Psaltis AJ, Bruhn MA, Ooi EH, Tan LW, Wormald PJ (2007) Nasal mucosa expression of lactoferrin in patients with chronic rhinosinusitis. Laryngoscope 117(11):2030–2035CrossRefPubMedGoogle Scholar
  23. 23.
    Ma Y, Zheng C, Shi L (2018) The role of YKL 40 in the pathogenesis of CRS with nasal polyps. Eur Arch Oto Rhino Laryngol 275(2):431–438CrossRefGoogle Scholar
  24. 24.
    Lechapt-Zalcman E, Coste A, d’Ortho MP, Frisdal E, Harf A, Lafuma C, Escudier E (2001) Increased expression of matrix metalloproteinase-9 in nasal polyps. J Pathol 193:233–241CrossRefPubMedGoogle Scholar
  25. 25.
    Lee YM, Kim SS, Kim HA, Suh YJ, Lee SK, Nahm DH, Park HS (2003) Eosinophil inflammation of nasal polyp tissue: relationships with matrix metalloproteinases, tissue inhibitor of metalloproteinase-1, and transforming growth factor-beta1. J Korean Med Sci 18:97–102CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bhandari A, Takeuchi K, Suzuki S, Harada T, Hayashi S, Imanaka-Yoshida K, Yoshida T, Majima Y (2004) Increased expression of matrix metalloproteinase-2 in nasal polyps. Acta Otolaryngol 124:1165–1170CrossRefPubMedGoogle Scholar
  27. 27.
    Becker KL, Snider R, Nylen ES (2010) Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. Br J Pharmacol 159:253–264CrossRefPubMedGoogle Scholar
  28. 28.
    Whang KT, Vath SD, Becker KL, Snider RH, Nylen ES, Muller B, Li Q, Tamarkin L, White JC (2000) Procalcitonin and pro-inflammatory cytokine interactions in sepsis. Shock 14:73–78CrossRefPubMedGoogle Scholar
  29. 29.
    Redl H, Schiesser A, Tögel E, Assicot M, Bohuon C (2001) Possible role of TNF on procalcitonin release in a baboon model of sepsis. Shock 16: 25–27CrossRefGoogle Scholar
  30. 30.
    Araujo M, Doi S, Palant CE, Nylen ES, Becker KL (2013) Procalcitonin induced cytotoxicity and apoptosis in mesangial cells: implications for septic renal injury. Inflamm Res 62(10):887–894CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OtorhinolarnyngologyUniversity of Health Sciences, Istanbul Education and Research HospitalFatih/İstanbulTurkey
  2. 2.Otorhinolaryngology ClinicLuleburgaz State HospitalKirklareliTurkey
  3. 3.Department of Medical Biochemistry, Medical Faculty CerrahpaşaUniversity of IstanbulIstanbulTurkey

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