Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis

Abstract

The aim of the present study was to determine which bronchoalveolar lavage fluid (BALF) and serological parameters reflect the severity of newly diagnosed pulmonary sarcoidosis.Seventy-four previously untreated sarcoid patients were categorised into three groups: 10 patients with Löfgren9s syndrome, 51 patients with stable disease and 13 patients with progressing disease requiring systemic steroid treatment.Total BALF cell count, percentage of alveolar lymphocytes and lymphocyte CD4/ CD8 ratio were not associated with severity of disease. Interestingly, a significant increase in percentages of BALF neutrophils (5.2¡1.1%) and eosinophils (1.7¡0.6%) was observed in sarcoid patients with progressing disease. Elevated percentages of these two cell types were the only BALF parameters associated with a more frequent necessity for systemic steroid therapy. This association between an elevated percentage of BALF neutrophils and the necessity for steroid treatment was observed in advanced as well as early sarcoidosis (radiological types I and II). Serum levels of soluble interleukin-2 receptor and neopterin were significantly elevated in progressing disease compared to stable disease or Löfgren9s syndrome.The present results demonstrate that increased percentages of neutrophils (w3.0%) and eosinophils (w1%) in bronchoalveolar lavage fluid from newly diagnosed pulmonary sarcoidosis is associated with a significantly higher risk of necessity for steroid therapy and may be helpful markers of progressive disease. Furthermore, of the serological parameters investigated, only serum levels of soluble interleukin-2 receptor and neopterin were associated with disease severity. Eur Respir J 2003; 21: 407-413.

T-helper cell type-1 transcription factor T-bet is upregulated in pulmonary sarcoidosis

“…Because radiographic staging provides limited information on prognosis and no information on disease activity and in order to exclude the influence of smoking on the gene expression, we further subdivided 56 nonsmoking patients according to the duration of symptoms as assessed by: follow-up at 2 yrs (remission n523, progression persistence n526; in seven patients, data after 2 yrs were not available); presence/absence of Löfgren's syndrome (LS; n58/48); and BAL cellular profile (patients with .11% BAL lymphocytes n545; patients with f11% BAL lymphocytes n511; patients with o85% BAL macrophages n511; patients with ,85% BAL macrophages n545). The reference values for BAL cell counts (o85% macrophages, f11% lymphocytes, f2.5% neutrophils and f1% eosinophils) were based on our own laboratory values and correspond to ZIEGENHAGEN et al [26]. Further subgroups were formed according to organ involvement (pulmonary involvement only n537; extrapulmonary involvement n519).…”

Relationship between radiologic patterns, pulmonary function values and bronchoalveolar lavage fluid cells in newly diagnosed sarcoidosis

“…One of the earliest and most common abnormalities of sarcoidosis is reduced DL CO . As the disease progresses, respiratory tract obstruction occurs (31)(32)(33). We determined statistically significant differences in the pulmonary function parameters of patients with different radiographic stages of sarcoidosis: PFT parameters significantly decreased from sarcoidosis stage I to stage III.…”

“…The increased neutrophil number, decreased lymphocyte count and CD4/CD8 ratio are associated with an increased radiographic stage of sarcoidosis. It is thought that the increased BALF neutrophil and/or eosinophil count is associated with a more advanced, chronic disease course (17,(31)(32)(33). The increase of the macrophages and neutrophil count, decrease of lymphocyte count and CD4/CD8 ratio with increased radiographic stage of sarcoidosis in BALF in patient with newly diagnosed sarcoidosis have been documented (17,23).…”

Prognostic Factors in Sarcoidosis

“…BAL lymphocytes >35 % predicted a good response to treatment, as indicated by an increase in FVC value in >90% of patients, whereas patients with low-intensity alveolitis deteriorated in 50% of cases, regardless of the treatment (Hollinger et al, 1985). Many authors did not find any differences in BAL lymphocytes content between subgroups of different prognosis as defined by radiological stage, chronicity or other factors (Vidal Serrano et al, 2005;Ziegenhagen et al, 2003); whereas some authors report higher intensity alveolitis in patients with stage I comparing to stage III (Danila et al, 2008;Verstraeten et al, 1990). Follow-up studies clearly show the lack of negative prognostic value of high lymphocyte content in BAL.…”

“…It was shown that patients with lower neutrophil count in BAL have a greater chance to recover spontaneously . Ziegenhagen et al reported on significantly elevated percentage of BALF neutrophils in patients with progressive disease, and found that increased percentage of neutrophils in BAL >3% may predict the future necessity of treatment (Ziegenhagen et al, 2003). Some authors reported on possible prognostic value of increased BALF eosinophils (Danila et al, 2008;Ziegenhagen et al, 2003) and mast cells (Bjermer et al, 1988).…”