Risk Factors Of Relapse In Pulmo Nary Sarcoidosis Treated With Corticosteroids

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clinical syndromes improvement with retaining or stable of radiographic abnormalities after corticosteroids were withdrawn for at least six months.The primary endpoint was the occurrence of relapse.Results Two hundred and three patients with newly biopsy-proven pulmonary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%).In univariate analysis,smoking history(HR = 3.599,95% CI 1.543–8.395,P = 0.003),increased percentages of circulating neutrophils(> 70%,HR = 2.277,95% CI 1.106– 4.689,P = 0.026),and lactate dehydrogenase(LDH)(HR = 1.003,95% CI 1.001–1.005,P = 0.011)were significantly associated with relapse in pulmonary sarcoidosis treated with corticosteroids.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(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 a useful information that the relapse and associated risk factors should be taken into considerations when determining treatment strategies for patients with pulmonary sarcoidosis.