Yi Zheng1, Hui Wang1, Qingqing Xu1, Xin Yan1, Yi Zhuang1, Hanyi Jiang1, Fanqing Meng2, Yonglong Xiao1, Hourong Cai1, Jinghong Dai3. 1. Department of Pulmonary and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. 2. Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. 3. Department of Pulmonary and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. daijinghong@nju.edu.cn.
Abstract
OBJECTIVE: To evaluate the incidence and risk factors of relapse in pulmonary sarcoidosis treated with corticosteroids. METHODS: Medical records of patients with pulmonary sarcoidosis were retrospectively reviewed. Clinical features, chest radiographs, pulmonary function tests, and treatment information were collected. The starting point was the date of diagnosis. Clinical relapse was defined as chest high-resolution computed tomography (HRCT) showing radiographic progression in combination of worsening of clinical symptoms to warrant retreatment following a decrease in dose or discontinuation of corticosteroids, without alternative causes such as infections, heart failure, or pulmonary embolism. Non-relapse was defined as remission of clinical symptoms and chest abnormalities, or clinical syndrome improvement with retention or stability of radiographic abnormalities after corticosteroids were withdrawn for at least 6 months. The primary endpoint was the occurrence of relapse. RESULTS: Two hundred three patients with newly biopsy-proven pulmonary sarcoidosis were enrolled over a 7-year period. Among them, 96 patients received corticosteroids therapy. Relapse occurred in 30 patients with the relapse rate yielding 30/96 (31.25%). After adjustment, multivariate analysis showed that smoking history (HR = 3.674 95% CI 1.573-8.581, P = 0.003) and increased percentages of circulating neutrophils (> 70%) (HR = 2.211, 95% CI 1.073-4.557, P = 0.032) were the significant predictors of relapse in pulmonary sarcoidosis treated with corticosteroids. CONCLUSIONS: This study provided useful information that the relapse and associated risk factors should be taken into considerations when determining treatment strategies for patients with pulmonary sarcoidosis.
OBJECTIVE: To evaluate the incidence and risk factors of relapse in pulmonary sarcoidosis treated with corticosteroids. METHODS: Medical records of patients with pulmonary sarcoidosis were retrospectively reviewed. Clinical features, chest radiographs, pulmonary function tests, and treatment information were collected. The starting point was the date of diagnosis. Clinical relapse was defined as chest high-resolution computed tomography (HRCT) showing radiographic progression in combination of worsening of clinical symptoms to warrant retreatment following a decrease in dose or discontinuation of corticosteroids, without alternative causes such as infections, heart failure, or pulmonary embolism. Non-relapse was defined as remission of clinical symptoms and chest abnormalities, or clinical syndrome improvement with retention or stability of radiographic abnormalities after corticosteroids were withdrawn for at least 6 months. The primary endpoint was the occurrence of relapse. RESULTS: Two hundred three patients with newly biopsy-proven pulmonary sarcoidosis were enrolled over a 7-year period. Among them, 96 patients received corticosteroids therapy. Relapse occurred in 30 patients with the relapse rate yielding 30/96 (31.25%). After adjustment, multivariate analysis showed that smoking history (HR = 3.674 95% CI 1.573-8.581, P = 0.003) and increased percentages of circulating neutrophils (> 70%) (HR = 2.211, 95% CI 1.073-4.557, P = 0.032) were the significant predictors of relapse in pulmonary sarcoidosis treated with corticosteroids. CONCLUSIONS: This study provided useful information that the relapse and associated risk factors should be taken into considerations when determining treatment strategies for patients with pulmonary sarcoidosis.
Authors: Robert P Baughman; Ralph Shipley; Sujal Desai; Marjolein Drent; Marc A Judson; Ulrich Costabel; Roland M du Bois; Mani Kavuru; Rozsa Schlenker-Herceg; Susan Flavin; Kim Hung Lo; Elliot S Barnathan Journal: Chest Date: 2009-04-24 Impact factor: 9.410
Authors: S P Matusiewicz; I J Williamson; P J Sime; P H Brown; P R Wenham; G K Crompton; A P Greening Journal: Eur Respir J Date: 1993-10 Impact factor: 16.671