Clinical phenotyping in sarcoidosis management

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Giuseppe Domenico Rana
Miriana D'alessandro
Luigi Rizzi
Laura Bergantini
Paolo Cameli
Alfredo Vozza
Piersante Sestini
Patrizia Suppressa
Elena Bargagli


sarcoidosis; biomarkers; phenotyping;


Background: Sarcoidosis is an heterogeneous granulomatous disease. Biological markers and clinical features could allow specific phenotypes to be associated with different prognosis, severity and treatment responses. This retrospective multicentre study aim to analyse the clinical and immunological features of sarcoidosis and to identify a routine non-invasive biomarker useful in clinical practice.

Materials and methods: 129 Caucasian patients (median age IQR, 56 (47-62)) were enrolled retrospectively in the study. Medical history, routine laboratory findings, lung function results and radiological features from the last examination of October 2019 – February 2020 were gathered from the patients' clinical records.

Results: Irrespective of the symptoms at disease onset, at the last clinical examination the treatment group contained the same percentages of symptomatic and asymptomatic patients. Stratifying sarcoidosis population according to therapeutic management, the N/L ratio was higher in the treated group than in the non-treated group (p=0.0034). Receiver operating curve (ROC) analysis distinguished these two groups according to N/L ratio with an area under the curve (AUC) of 65.3% and a best cut-off value of 2.21. Peripheral N/L ratio was significantly higher in radiological stages 2-4 than in stages 0-1 (p=0.0090) distinguishing these two groups with an AUC of 64% and a best cut-off value of 2.13.

Discussion: In our multicentric cohort study similar periodic follow-up can be suggested for symptomatic and asymptomatic sarcoidosis patients at onset. In the heterogeneous context of this disease, N/L ratio proved to be a useful and simple routine laboratory biomarker related to disease activity and need for treatment.


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