Evaluation of the role of clinical and radiological findings in predicting the pulmonary exacerbation of sarcoidosis

Abstract

Aims: Pulmonary exacerbations of sarcoidosis (are associated with increased morbidity, treatment escalation, and worse long term outcomes. However, reliable predictors for exacerbations remain unclear. This study aimed to identify clinical, laboratory, and radiological factors associated with pulmonary exacerbations of sarcoidosis and to determine potential early predictors of exacerbations. Methods: A retrospective cohort study was conducted on 107 patients diagnosed with pulmonary sarcoidosis within the past five years. Patients were categorized into an exacerbation group (n=57) and a non-exacerbation group (n=50). Exacerbation was defined as worsening of respiratory symptoms and/or radiological findings lasting ≥14 days, with no alternative acute underlying causes such as infections or irritant exposure. Demographic data, environmental exposures, results of pulmonary function tests (PFTs), and six-minute walk test (6MWT), systolic pulmonary arterial pressure (PAP), laboratory parameters, treatment regimens, and high-resolution computed tomography (HRCT) findings were analyzed. Results: Pulmonary exacerbations of sarcodosis were seen in 27.5% of our cases. Significant differences were found between groups in terms of extrapulmonary organ involvement, recurrent acute respiratory infections, environmental exposure, disease stage, PAP, PFT results, urinary calcium levels, and corticosteroid use (p<0.05). HRCT showed more severe parenchymal damage and fibrosis in the exacerbation group (p=0.005). In multivariate analysis, frequent acute respiratory infections were identified as the strongest independent predictor of pulmonary exacerbations (OR=5.166, p=0.002). Conclusion: Pulmonary exacerbations of sarcoidosis have a multifactorial etiology, with recurrent respiratory infections being a strong independent predictor. HRCT findings, particularly parenchymal damage and fibrosis, provide significant prognostic value. Early identification of high-risk patients may enable timely interventions and improved management.

Keywords

• Pulmonary sarcoidosis
• exacerbation
• HRCT
• fibrosis
• risk factors
• acute respiratory infections

Pulmoner sarkoidoz alevlenmesini tahmin etmede klinik ve radyolojik bulguların rolünün değerlendirilmesi

Abstract

AMAÇ Pulmoner Sarkoidozdaki (PS) eksaserbasyonlar (alevlenmeler) hem hastalığın klinik yönetimini hem de prognozunu önemli ölçüde kötüleştirmektedir. Ancak, bunların insidansı (ne sıklıkla meydana geldikleri) ve ilişkili risk faktörleri hakkında belirgin bir veri yetersizliği mevcuttur. Bu çalışma, Pulmoner Sarkoidozda eksaserbasyonları tahmin etmek için erken risk faktörlerini ve yeni biyobelirteçleri (klinik, biyokimyasal ve radyolojik) belirlemeyi amaçlayarak, daha etkili tedavilere ve semptom yükünün azalmasına katkıda bulunmayı hedeflemektedir. YÖNTEMLER Bu çalışma, son 5 yıl içinde Pulmoner Sarkoidoz tanısı konmuş 107 hastayı karşılaştırmış ve onları eksaserbasyon (n=57) ve eksaserbasyon olmayan (n=50) gruplarına ayırmıştır. Geriye dönük analiz, demografik verileri, kan biyokimyasal değerlerini (hemoglobin, nötrofil, lenfosit, üre, monosit, ACE, kalsiyum, trombosit), çevresel maruziyetleri, sık geçirilen enfeksiyonları, solunum fonksiyon testlerini, pulmoner arter basıncını, alınan tedaviyi, radyolojik bulguları ve 6 dakikalık yürüme testi sonuçlarını içermiştir. Grup farklılıkları ve eksaserbasyon risk faktörleri uygun istatistiksel yöntemler ve lojistik regresyon kullanılarak değerlendirilmiştir. BULGULARİki grup karşılaştırıldığında, eksaserbasyon geçirenlerde organ tutulumu (p=0.032), sık alt solunum yolu enfeksiyonları (p=0.004), çevresel maruziyet (p=0.002), hastalık evresi (p=0.005), pulmoner arter basıncı (p=0.001), akciğer fonksiyon testleri (p=0.001), idrar kalsiyumu (p<0.0001), kortizon kullanımı (p=0.037), trombosit sayısı (p=0.001), üre (p=0.021), monosit düzeyleri (p=0.008) ve torasik BT bulguları (p=0.005) açısından istatistiksel olarak anlamlı farklılıklar bulunmuştur. SONUÇ Bu çalışma, Pulmoner Sarkoidozlu bireylerde eksaserbasyonların uzun vadeli gelişimi ve ilişkili erken evre risk faktörleri üzerine yenilikçi bir bakış açısı sunmaktadır. Bulgularımız, başlangıçtaki risk faktörlerinin PS'de eksaserbasyon olasılığını tahmin etmek için uygulanabilir ve klinik olarak anlamlı bir yaklaşım sağlayabileceğini düşündürmektedir.

Keywords

• sarkoidoz
• alevlenme
• erken evre risk faktörleri

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