Novel biomarkers for the assessment of disease activity in patients with sarcoidosis: a case-control study

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Hosam Hosny Masoud
Amani Moustafa Ali
Fatma AbdelWahab
Hoda M. Abdel-Hamid


Sarcoidosis, Activity, Monocyte/HDL-C ratio, Neutrophil lymphocyte ratio, platelet lymphocyte ratio, lymphocytes monocytes ratio, biomarkers


Background and aim: The prognosis of sarcoidosis is challenging and largely depends on the persistence of disease activity and the degree of organ dysfunction. Various biomarkers have been evaluated for diagnosis, disease activity assessment, and prognosis. This study aimed to determine if the ratios of monocytes to high-density lipoprotein cholesterol (MHR), platelets to lymphocytes (PLR), neutrophils to lymphocytes (NLR), and lymphocytes to monocytes ratio (LMR) could be used as novel sarcoidosis activity markers. Methods: In a case-control study, 54 patients with biopsy-confirmed sarcoidosis were divided into two groups; group 1: consisted of 27 patients with active sarcoidosis who were newly diagnosed and treatment-naive, and group 2: consisted of 27 patients with inactive sarcoidosis who had been on treatment for at least 6 months. All patients were subjected to a comprehensive history, physical examination, laboratory tests, chest imaging, spirometry, and screening for extrapulmonary organ involvement by means of electrocardiogram and eye examination. Results: The mean age of the patients was 44 ± 11 years (79.6% were females & 20.4% were males). MHR, NLR, and LMR were significantly higher in patients with active sarcoidosis than in an inactive disease with a cut-off value of 8.6, a sensitivity of 81.5%, and a specificity of 70.4% (P-value < 0.001), a cut-off value of 1.95, sensitivity of 74% and specificity of 66.7% (P-value 0.007) and a cut-off value of < 4, a sensitivity of 81.5%, and a  specificity of 85.2% (P-value < 0.001), respectively. In contrast, PLR was not statistically significant between active and inactive sarcoidosis patients. Conclusions: The lymphocytes monocytes ratio is a highly sensitive and specific biomarker that could be used to assess the disease activity in sarcoidosis patients.


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1. Drent M, Crouser ED, Grunewald J. Challenges of sarcoidosis and its management. N Engl J Med. 2021; 385(11):1018-32.
2. Judson MA, Boan AD, Lackland DT. The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States. Sarcoidosis Vasc Diffuse Lung Dis. 2012; 29(2):119-27.
3. Pereira CA, Dornfeld MC, Baughman R, et al. Clinical phenotypes in sarcoidosis. Curr Opin Pulm Med. 2014; 20(5):496-502.
4. Costabel U, Bois RD, Eklund A, et al. Consensus conference: activity of sarcoidosis. Eur Respir J. 1994; 7(3):624-7.
5. Lopes MC, Amadeu TP, Ribeiro-Alves M, et al. Identification of active sarcoidosis using chitotriosidase and angiotensin-converting enzyme. Lung. 2019; 197(3):295-302.
6. Chopra A, Kalkanis A, Judson MA. Biomarkers in sarcoidosis. Expert Rev Clin Immunol. 2016; 12(11):1191-208.
7. Yildiz P, Elverisli MF. Monocyte/HDL ratio in sarcoidosis patients without treatment. Annals of Medical Research 2020; 27(6): 1728-32.
8. Üçsular F, Polat G, Karadeniz G, et al. Predictive value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with hypersensitivity pneumonia. Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(4).
9. Alamdari MG, Kalami N, Shojaan H, Aminizadeh S, Ghaedi A, Bazrgar A, Khanzadeh S. Systematic review of the diagnostic role of neutrophil to lymphocyte ratio in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2023;40(1).
10. Zhao Y, Hao C, Bo X, Lu Z, Qian H, Chen L. The prognostic value of admission lymphocyte-to-monocyte ratio in critically ill patients with acute myocardial infarction. BMC Cardiovasc Disord. 2022 Dec;22(1):1-0.
11. Turkmen D, Altunisik N, Sener S. Investigation of monocyte HDL ratio as an indicator of inflammation and complete blood count parameters in patients with acne vulgaris. Int J Clin Pract. 2020; 74(12):e13639.
12. Korkmaz C, Demircioglu S. The association of neutrophil/lymphocyte and platelet/lymphocyte ratios and hematological parameters with diagnosis, stages, extrapulmonary involvement, pulmonary hypertension, response to treatment, and prognosis in patients with sarcoidosis. Can Respir J. 2020.
13. Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020; 201(8):e26-51.
14. Thillai M, Atkins CP, Crawshaw A, et al. BTS Clinical Statement on pulmonary sarcoidosis. Thorax. 2021; 76(1):4-20.
15. Obi ON, Judson MA, Birring SS, et al. Assessment of dyspnea in sarcoidosis using the Baseline Dyspnea Index (BDI) and the Transition Dyspnea Index (TDI). Respir Med. 2022; 191:106436.
16. Lee GM, Pope K, Meek L, et al. Sarcoidosis: a diagnosis of exclusion. AJR Am J Roentgenol. 2020; 214(1):50-8.
17. Lepzien R, Liu S, Czarnewski P, et al. Monocytes in sarcoidosis are potent tumor necrosis factor producers and predict disease outcome. Eur Respir J. 2021; 58(1).
18. Sweiss NJ, Salloum R, Gandhi S, et al. Correction: Significant CD4, CD8, and CD19 lymphopenia in the peripheral blood of sarcoidosis patients correlate with severe disease manifestations. PloS one. 2010; 5(2).
19. Crouser ED, Lozanski G, Fox CC, et al. The CD4+ lymphopenic sarcoidosis phenotype is highly responsive to anti-tumor necrosis factor-α therapy. Chest. 2010; 137(6):1432-5.
20. Ahmadzai H, Loke WS, Huang S, et al. Biomarkers in sarcoidosis: a review. Curr Biomark Find 2014; 4:93-106.
21. Gupta D, Rao VM, Aggarwal AN, et al. Hematological abnormalities in patients of sarcoidosis. Indian J Chest Dis Allied Sci. 2002; 44(4):233-6.
22. Iliaz S, Iliaz R, Ortakoylu G, et al. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med. 2014; 9(4):232.
23. Salazar A, Maña J, Pinto X, et al. Low levels of high-density lipoprotein cholesterol in patients with active sarcoidosis. Atherosclerosis. 1998; 136(1):133-7.
24. Salazar A, Mañá J, Pintó X, et al. Corticosteroid therapy increases HDL-cholesterol concentrations in patients with active sarcoidosis and hypoalphalipoproteinemia. Clin Chim Acta. 2002; 320(1-2):59-64.
25. Ivanišević J, Kotur-Stevuljević J, Stefanović A, et al. Dyslipidemia and oxidative stress in sarcoidosis patients. Clinbiochem. 2012; 45(9):677-82.