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Potential Usefulness of Inflammatory Markers to Monitor Respiratory Functional Impairment in Sarcoidosis

Snjeana Rothkrantz-Kos^1,3, Marja P. van Dieijen-Visser^1,3,a, Paul G.H. Mulder⁴ and Marjolein Drent^2,3

Departments of
¹ Clinical Chemistry and of
² Respiratory Medicine, Sarcoidosis Management Center, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands.
³ Nutrition and Toxicology Research Institute Maastricht (NUTRIM), University Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.

⁴ Department of Epidemiology and Biostatistics, Erasmus University of Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

^aAddress correspondence to this author at: University Hospital of Maastricht, Department of Clinical Chemistry, PO BOX 5800, 6202 AZ Maastricht, The Netherlands. Fax 31-43-387-4692; e-mail dieijen{at}klinchem.azm.nl.

Background: Sarcoidosis is a multiorgan inflammatory granulomatous disorder of unknown origin for which adequate markers to monitor disease severity are lacking. The aim of this study was to evaluate the potential clinical usefulness of serologic markers of inflammation [high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA)], T-cell activation [soluble interleukin-2 receptor (sIL2R)], and granuloma formation [angiotensin-converting enzyme (ACE)] for monitoring of sarcoidosis.

Methods: Of the 185 sarcoidosis patients who visited the Sarcoidosis Management Center between 1999 and 2002, we selected 144 nonsmoking patients: 73 untreated (group I) and 71 treated (group II). Subgroups of the untreated patients [group Ia (nonchronic group with time since diagnosis 2 years) and group Ib (chronic group with time since diagnosis >2 years)] were evaluated separately. ROC curves and logistic regression analyses were used to compare the diagnostic accuracy of different markers to assess disease severity. Pulmonary disease severity was defined by lung function test results.

Results: In untreated subgroup Ia and the total untreated group (group I), sIL2R had the largest areas under the curves (AUCs; 0.891 and 0.799, respectively) and the highest sensitivity (82% and 64%), specificity (94% and 88%), and positive (82% and 70%) and negative (94% and 88%) predictive values among the evaluated markers in both untreated groups. Nevertheless, the confidence intervals for sIL2R AUC, sensitivity, and specificity were broad and partly overlapped those of ACE, hs-CRP, and SAA. In the treated group (group II), all four markers appeared to have comparable AUCs, ranging from 0.645 for SAA to 0.711 for sIL2R.

Conclusion: sIL2R appears to be useful for monitoring respiratory disease severity in sarcoidosis. We recommend sIL2R measurement in the follow-up of patients with sarcoidosis.

The following articles in journals at HighWire Press have cited this article:

				F G Joseph and N J Scolding Sarcoidosis of the nervous system Practical Neurology, August 1, 2007; 7(4): 234 - 244. [Abstract] [Full Text] [PDF]

				H. Biller, G. Zissel, B. Ruprecht, M. Nauck, A. Busse Grawitz, and J. Muller-Quernheim Genotype-corrected reference values for serum angiotensin-converting enzyme Eur. Respir. J., December 1, 2006; 28(6): 1085 - 1091. [Abstract] [Full Text] [PDF]