Background Basic studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect chronic rhinosinusitis (CRS), but there is unclear real-world evidence regarding the association of underlying CRS with the risk for SARS-CoV-2 infection and severe coronavirus disease 19 (COVID-19). Objective We aimed to determine whether CRS is associated with increased risk for SARS-CoV-2 infection and severe COVID-19. Methods Altogether, 219,959 adult patients who tested for SARS-CoV-2 in South Korea from January 1 to May 15, 2020 (excluding self-referral) were identified in this nested case-control study with propensity score matching. Data on SARS-CoV-2 test results and COVID-19 worsened outcomes (ie, the need for oxygen therapy, intensive care, or mechanical ventilation, and death) were obtained from the Health Insurance Review and Assessment Service of Korea. Results In this matched cohort, 380 of 12,217 patients with CRS (3.1%) tested positive for SARS-CoV-2 infection, compared with 310 patients without CRS (2.5%; adjusted odds ratio = 1.22; 95% confidence interval, 1.04-1.42). Moreover, 60 of 286 COVID-19 patients with CRS (21.0%) had severe COVID-19 outcomes, compared with 38 without CRS (13.3%; adjusted odds ratio = 1.71; 95% confidence interval, 1.09-2.71). Subgroup analysis identified that CRS patients with an absence of nasal polyps, prior intranasal corticosteroid use, or nonatopic type had a greater risk for SARS-CoV-2 infection and severe COVID-19 outcomes. Conclusions In patients with CRS, prior intranasal corticosteroid use, the absence of nasal polyps, or nonatopic type was associated with increased risk for SARS-CoV-2 infection and severe COVID-19 in the Korean nationwide cohort. Clinicians should be cautious in determining prognosis and care for patients with CRS amid the COVID-19 pandemic.
【저자키워드】 COVID-19, COVID-19, Coronavirus disease 2019, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2, TMPRSS2, Transmembrane serine protease 2, IFN, interferon, Chronic rhinosinusitis, CI, Confidence interval, ACE2, angiotensin converting enzyme II, Intranasal corticosteroids, Severe acute respiratory syndrome 2, aOR, adjusted odds ratio, Nasal polyp, CRS, Chronic rhinosinusitis, CRSsNP, Chronic rhinosinusitis without nasal polyp, CRSwNP, Chronic rhinosinusitis with nasal polyp, ICD-10, International Classification of Disease, 10th revision, KCDC, Korea Centers for Disease Control and Prevention, SMD, Standardized mean difference,