The ACE/lymphocyte ratio and CONUT score: Key predictors of extrapulmonary involvement and recurrence in sarcoidosis

Kadir Canoglu; Omer Ayten; Gokce Kulah; Hasan Furkan Avci; Ilyas Kocabag; Erhan Ogur; Insa Gul  Ekiz Iscanli

doi:10.36141/svdld.v42i1.15564

Authors

Kadir Canoglu Sultan 2. Abdulhamid Han Training and Research Hospital, Pulmonology, Istanbul, Türkiye
Omer Ayten Liv Vadi Istanbul Hospital, Pulmonology, Istanbul, Türkiye
Gokce Kulah Umraniye Training and Research Hospital, Pulmonology, Istanbul, Türkiye
Hasan Furkan Avci Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Immunology and Allergy, Istanbul, Türkiye
Ilyas Kocabag Sultan 2. Abdulhamid Han Training and Research Hospital, Department of Pulmonology, Istanbul
Erhan Ogur Sultan 2. Abdulhamid Han Training and Research Hospital, Department of Pulmonology, Istanbul
Insa Gul Ekiz Iscanli Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit, Istanbul, Türkiye

Keywords:

ace/lymphocyte ratio, conut score, extrapulmonary sarcoidosis, recurrence predictors, angiotensin converting enzyme, nutritional status, sarcoidosis outcomes, disease recurrence

Abstract

Background and aim: Extrapulmonary involvement is associated with high morbidity and mortality in sarcoidosis. Sarcoidosis recurrence rates vary between 37-75% in the literature. In this study, we aimed to investigate the association of ACE/lymphocyte ratio and CONUT score with systemic involvement and recurrence in sarcoidosis.

Methods: 156 adult patients diagnosed with sarcoidosis was conducted in this retrospective, single-center study between 01.09.2016 - 31.12.2021 in the pulmonology clinic of Sultan 2. Abdulhamid Han Training and Research Hospital in Istanbul/Türkiye. The ACE/lymphocyte ratio was calculated by dividing the serum ACE level by lymphocyte count. CONUT score was calculated according to serum albumin, lymphocyte count and total cholesterol levels.

Results: Fifty (32%) patients had systemic involvement. In patients with systemic involvement, serum ACE and ACE/lymphocyte ratio were higher and lymphocytes were lower than those without systemic involvement (p<0.05). 24 (15.4%) patients had recurrence. Serum ACE and ACE/lymphocyte ratio were found to be higher in patients with recurrence compared to those without recurrence (p<0.05). There was no statistically significant difference between the groups in terms of CONUT score (p=0.232). In Spearmen's Rho correlation, systemic involvement and recurrence were positively correlated with ACE/lymphocyte ratio (p<0.05). In Binary Logistic Regression, ACE/lymphocyte ratio was not associated with recurrence and systemic involvement (p>0.05). In ROC curve analysis, the sensitivity, specificity and AUC of ACE/lymphocyte ratio in predicting systemic involvement were 78%, 39.8% and 0.644, respectively with a cut-off value of 19.55; and in predicting recurrence were 79.2%, 44.8% and 0.714, respectively with a cut-off value of 22.41.

Conclusions: The ACE/lymphocyte ratio, which was evaluated for the first time in the literature, may be used to predict extrapulmonary involvement, which can have high mortality and morbidity, as well as recurrence in post-treatment follow-up.

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