Purpose

We performed a retrospective analysis of a sarcoidosis cohort who had sACE obtained at their initial clinic visit, but the treating physician was blinded to the results. We examined the relationship between sACE and the treating physician’s decision to escalate sarcoidosis treatment.

Methods

Treatment was considered escalated if the prednisone dose was increased or if the prednisone dose was not changed but an additional anti-sarcoidosis drug was added or the dose was increased.

Results

561 sarcoidosis patients were analyzed. The most common target organ was the lung (84%). Using a cut-off of > 82 units/L for an elevated sACE, 31/82 (38%) with an elevated sACE had treatment escalation whereas 91/497 (18%) had treatment escalation with a normal sACE (p < 0.0001). For the need of treatment escalation, a sACE (cut-off of > 82) had sensitivity 0.25, specificity 0.89, positive predictive value 0.38, negative predictive value 0.81. These results were not appreciably different using other sACE cut-off values such as 70, 80, 90, or 100. A multivariable logistic regression model that included demographics, the target organ, spirometry results estimated that sACE level and lower FVC were significantly associated with the likelihood of treatment escalation. These findings held when sACE > 82 replaced sACE level in the multivariable logistic regression model.

Conclusions

Although there was a strong correlation between sACE at the initial sarcoidosis clinic visit and subsequent treatment escalation of sarcoidosis, the predictive power was such that sACE is not adequately reliable to be used in isolation to make this determination.

中文翻译：

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血清血管紧张素转换酶水平与结节病升级治疗决策之间的关系

目的

我们对首次就诊时获得 sACE 的结节病队列进行了回顾性分析，但治疗医生对结果不知情。我们研究了 sACE 与治疗医生决定升级结节病治疗之间的关系。

方法

如果增加泼尼松剂量或不改变泼尼松剂量但添加额外的抗结节病药物或增加剂量，则认为治疗升级。

结果

对 561 名结节病患者进行了分析。最常见的靶器官是肺（84%）。对于升高的 sACE，使用 > 82 单位/L 的截止值，31/82 (38%) 的 sACE 升高的患者进行了治疗升级，而 91/497 (18%) 的患者在 sACE 正常的情况下进行了治疗升级 (p < 0.0001  ) 。对于治疗升级的需要，sACE（截止值> 82）的敏感性为0.25，特异性为0.89，阳性预测值为0.38，阴性预测值为0.81。使用其他 sACE 截止值（例如 70、80、90 或 100），这些结果没有明显不同。包括人口统计、目标器官、肺量测定结果在内的多变量逻辑回归模型估计，sACE 水平和较低的 FVC 与治疗升级的可能性。当 sACE > 82 取代多变量逻辑回归模型中的 sACE 水平时，这些发现成立。

结论

尽管初次结节病门诊就诊时的 sACE 与结节病随后的治疗升级之间存在很强的相关性，但预测能力如此之大，以至于 sACE 不足以单独用于做出这一决定。