{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:07:22Z","timestamp":1789106842712,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic Rhinosinusitis (CRS), particularly its eosinophilic endotype (ECRS), is frequently associated with comorbid lower airway diseases. The JESREC score is a clinical tool for predicting ECRS. This study aimed to evaluate the association between the JESREC score and pulmonary dysfunction in adult CRS patients and to explore the potential role of metabolic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients were categorized based on pulmonary function tests and multivariate logistic regression analyses were performed to identify associated factors for overall pulmonary dysfunction and its restrictive and obstructive subtypes. The discriminative ability of the JESREC score was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Furthermore, mediation models were constructed to figure out the mediating role of metabolic factors (BMI, blood pressure, fasting blood glucose and serum lipidomic profiles).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 143 patients were included in the final analysis. The JESREC score was significantly higher in patients with pulmonary dysfunction (8.6 vs. 5.0,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Multivariate analysis confirmed the JESREC score (OR, 1.24, 95% CI, 1.12\u20131.37) and ECRS (5.17, 2.05\u201313.09) as associated factors for pulmonary dysfunction, including both restrictive and obstructive subtypes. The ROC curve showed an AUC of 0.729, with an optimal JESREC cutoff of 4.5. Mediation analysis indicated that systolic blood pressure, diastolic blood pressure, triglycerides, and HDL-C significantly mediated 6.4%, 4.5%, 8.4%, and 6.5% of the total effect, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>JESREC score was independently associated with pulmonary dysfunction in CRS patients, and metabolic factors may statistically mediate part of this association, suggesting a potential pathway. Furthermore, patients with JESREC score\u2009\u2265\u20095 may warrant special attention to pulmonary function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1859696","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:29:36Z","timestamp":1789104576000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["JESREC score, metabolic factors, and pulmonary dysfunction: analysis among adult patients with chronic rhinosinusitis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ling","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, The First People\u2019s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixiang","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The First People\u2019s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Endocrine and Metabolic Diseases, The Second People\u2019s Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Nanjing Medical University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianqiang","family":"You","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The First People\u2019s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1001\/jama.2025.10887","article-title":"Phenotype to endotype-the future of chronic rhinosinusitis","volume":"334","author":"Platt","year":"2025","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1016\/j.alit.2025.03.006","article-title":"Examining effects of race and chronic rhinosinusitis on asthma; more evidence for unified-airway diseases","volume":"74","author":"Moore","year":"2025","journal-title":"Allergol Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s11882-024-01184-4","article-title":"Current review of comorbidities in chronic rhinosinusitis","volume":"25","author":"Choi","year":"2024","journal-title":"Curr Allergy Asthma Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"273","DOI":"10.2147\/COPD.S493219","article-title":"Chronic airflow limitation, lower respiratory symptoms, COPD and chronic rhinosinusitis in a middle-aged population: the Swedish CArdioPulmonary bioImage study (SCAPIS). A link between the lower and upper airways","volume":"20","author":"Andersson","year":"2025","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3116","DOI":"10.1016\/j.jaip.2024.07.027","article-title":"Associations between chronic rhinosinusitis and the development of non-cystic fibrosis bronchiectasis","volume":"12","author":"Kim","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B6","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.alit.2024.10.008","article-title":"Elevated MS4A2 and IgE interaction in nasal polyps contributing to poor postoperative prognosis in patients with eosinophilic chronic rhinosinusitis","volume":"74","author":"Nakano","year":"2025","journal-title":"Allergol Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/all.12644","article-title":"Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC study","volume":"70","author":"Tokunaga","year":"2015","journal-title":"Allergy"},{"key":"B8","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/j.anl.2020.04.006","article-title":"Comparison of olfactory and taste functions between eosinophilic and non-eosinophilic chronic rhinosinusitis","volume":"47","author":"Ahn","year":"2020","journal-title":"Auris Nasus Larynx"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1334656","DOI":"10.3389\/fimmu.2024.1334656","article-title":"Association between peripheral eosinophilia, JESREC score, and olfactory dysfunction in patients with chronic rhinosinusitis","volume":"15","author":"Zhang","year":"2024","journal-title":"Front Immunol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000545077","article-title":"Predictors of the need for additional postoperative treatment for eosinophilic chronic rhinosinusitis","volume":"87","author":"Saito","year":"2025","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2563395","DOI":"10.1080\/20018525.2025.2563395","article-title":"The prevalence and risk factors of respiratory symptoms in Finland: a comparative analysis","volume":"12","author":"Pautola","year":"2025","journal-title":"Eur Clin Respir J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"5683","DOI":"10.1007\/s00405-025-09709-x","article-title":"Impact of body mass index on chronic rhinosinusitis: disease burden and treatment outcomes","volume":"282","author":"S.","year":"2025","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1848","DOI":"10.1111\/all.16620","article-title":"The evolution, immunopathogenesis and biomarkers of type 2 inflammation in common allergic disorders","volume":"80","author":"Gao","year":"2025","journal-title":"Allergy"},{"key":"B14","doi-asserted-by":"publisher","first-page":"13855","DOI":"10.1038\/s41598-025-98175-w","article-title":"Exploring the comorbidity association and biological mechanisms of chronic rhinosinusitis and chronic obstructive pulmonary disease","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1388585","DOI":"10.3389\/fmed.2024.1388585","article-title":"A clinical study on the relationship between chronic rhinosinusitis and bronchial asthma","volume":"11","author":"Kang","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4193\/Rhino12.000","article-title":"EPOS 2012: european position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists","volume":"50","author":"Fokkens","year":"2012","journal-title":"Rhinology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1002\/lio2.1061","article-title":"Analysis of risk factors affecting olfactory dysfunction in patients with chronic rhinosinusitis: highlighting the role of metabolic syndrome","volume":"8","author":"Zhang","year":"2023","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"667","DOI":"10.3978\/j.issn.2072-1439.2013.10.16","article-title":"Chinese Guideline for the prevention and management of bronchial asthma (primary health care version)","volume":"5","year":"2013","journal-title":"J Thorac Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"103814","DOI":"10.1016\/j.amjoto.2023.103814","article-title":"Rethinking the relationships between chronic rhinosinusitis and asthma severity","volume":"44","author":"Gilani","year":"2023","journal-title":"Am J Otolaryngol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.otc.2022.09.015","article-title":"Unified airway disease: diagnosis and subtyping","volume":"56","author":"Miglani","year":"2023","journal-title":"Otolaryngol Clin North Am"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1016\/j.jaci.2024.10.007","article-title":"Upper airway comorbidities of asthma","volume":"154","author":"Jung","year":"2024","journal-title":"J Allergy Clin Immunol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.alit.2023.06.005","article-title":"Allergic fungal rhinosinusitis: what we can learn from allergic bronchopulmonary mycosis","volume":"72","author":"Nakayama","year":"2023","journal-title":"Allergol Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s00011-025-02110-8","article-title":"MUC1 In the upper-lower airway inflammatory continuum: an endotype-centered perspective","volume":"74","author":"Meng","year":"2025","journal-title":"Inflamm Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"100094","DOI":"10.1016\/j.waojou.2019.100094","article-title":"A novel pathophysiologic link between upper and lower airways in patients with chronic rhinosinusitis: association of sputum periostin levels with upper airway inflammation and olfactory function","volume":"13","author":"Kanemitsu","year":"2020","journal-title":"World Allergy Organ J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"12421","DOI":"10.2147\/JIR.S521238","article-title":"Targeting eosinophils in asthmatic inflammation: benefits and drawbacks","volume":"18","author":"Broide","year":"2025","journal-title":"J Inflamm Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"17534666251335800","DOI":"10.1177\/17534666251335800","article-title":"Eosinophils in chronic obstructive pulmonary disease","volume":"19","author":"Vanetti","year":"2025","journal-title":"Ther Adv Respir Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1080\/01902148.2019.1636899","article-title":"Restrictive lung disease in TNF-transgenic mice: correlation of pulmonary function testing and micro-CT imaging","volume":"45","author":"Wu","year":"2019","journal-title":"Exp Lung Res"},{"key":"B28","first-page":"29","article-title":"Respiratory conditions update: restrictive lung disease","volume":"448","author":"Robinson","year":"2016","journal-title":"FP Essent"},{"key":"B29","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1089\/met.2022.0045","article-title":"Pulmonary function in metabolic syndrome: a meta-analysis","volume":"20","author":"Fang","year":"2022","journal-title":"Metab Syndr Relat Disord"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e001792","DOI":"10.1136\/bmjresp-2023-001792","article-title":"Association between serum high-density lipoprotein cholesterol and lung function in adults: three cross-sectional studies from US and Korea national health and nutrition examination survey","volume":"10","author":"Lee","year":"2023","journal-title":"BMJ Open Respir Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"17534666251320875","DOI":"10.1177\/17534666251320875","article-title":"Protective effects of statins on pulmonary function in patients with persistent hyperlipidemia: a retrospective cohort study","volume":"19","author":"Shen","year":"2025","journal-title":"Ther Adv Respir Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1093\/aje\/155.9.842","article-title":"Lipids and pulmonary function in the third national health and nutrition examination survey","volume":"155","author":"Cirillo","year":"2002","journal-title":"Am J Epidemiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.1194\/jlr.M004549","article-title":"Genetic deletion of apolipoprotein A-I increases airway hyperresponsiveness, inflammation, and collagen deposition in the lung","volume":"51","author":"Wang","year":"2010","journal-title":"J Lipid Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"L991","DOI":"10.1152\/ajplung.00013.2008","article-title":"Apoetm1Unc mice have impaired alveologenesis, low lung function, and rapid loss of lung function","volume":"294","author":"Massaro","year":"2008","journal-title":"Am J Physiol Lung Cell Mol Physiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1859696\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:29:38Z","timestamp":1789104578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1859696\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1859696"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1859696","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"article-number":"1859696"}}