Poor Outcome and Mortality in Patients with Lower Lung-Dominant Sarcoidosis

• Published in: Canadian respiratory journal Vol. 2023; pp. 3624344 - 8
• Main Authors: Tachibana, Kazunobu, Akira, Masanori, Arai, Toru, Sugimoto, Chikatoshi, Hayashi, Seiji, Inoue, Yoshikazu
• Format: Journal Article
• Language: English
• Published: Egypt Hindawi 15.04.2023; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Aged; Carbon monoxide; Enzymes; Female; Granulomas; Hospitals; Humans; Lavage; Lung - pathology; Lung diseases; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Patient outcomes; Patients; Physiological aspects; Pneumonia; Proteins; Pulmonary hypertension; Respiratory Function Tests; Retrospective Studies; Risk factors; Sarcoidosis; Sarcoidosis, Pulmonary - mortality; Sentinel Lymph Node Biopsy; Statistical analysis; Surfactants; Vital Capacity; Japan; United States > US
• ISSN: 1198-2241; 1916-7245
• DOI: 10.1155/2023/3624344

Background. Pulmonary sarcoidosis predominantly affects the upper lung zones but sometimes affects the lower lung zones. We hypothesised that patients with lower lung zone-dominant sarcoidosis had lower baseline forced vital capacity, progressive restrictive lung function decline, and higher long-term mortality. Methods. We retrospectively reviewed clinical data including the pulmonary function tests of 108 consecutive patients with pulmonary sarcoidosis pathologically confirmed by lung and/or mediastinal lymph node biopsy from 2004 to 2014 from our database. Results. Eleven patients (10.2%) with lower lung zone-dominant sarcoidosis were compared with 97 patients with nonlower lung zone-dominant sarcoidosis. The median age of the patients with lower dominance was significantly older (71 vs. 56, p=0.0005). The patient with lower dominance had a significantly lower baseline percent forced vital capacity (FVC) (96.0% vs. 103%, p=0.022). The annual change in FVC was −112 mL in those with lower dominance vs. 0 mL in nonlower dominance (p=0.0033). Fatal acute deterioration was observed in three patients (27%) in the lower dominant group. Overall survival in the lower dominant group was significantly worse. Conclusions. Patients with lower lung zone-dominant sarcoidosis had an older age and lower baseline FVC with disease progression and acute deterioration associated with higher long-term mortality.