PURPOSE: Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology. The unpredictable clinical course of the disease has prompted research into biomarkers useful for predicting outcome. Among the potential markers of sarcoidosis, a recently proposed indicator was chitotriosidase, a chitinase produced by activated macrophages. In 2007 chitotriosidase activity was analyzed for the first time in a group of 96 patients with sarcoidosis in order to assess chitotriosidase specificity as a marker of sarcoidosis.((Bargagli E et al. Respiration 2007; 74: 548-552).In this study we wanted to evaluate value of chitotriosidase as a marker of sarcoidosis activity in our patients.
METHODS: 217 biopsy positive sarcoidosis patients were analyzed (159 female/ 58 male). 80/217 patients had acute sarcoidosis, (duration less than 2 years), 137/217 pts with chronic sarcoidosis (duration longer than 2 years).At the time of the study 105/217 patients had symptoms and signs of active disease; 57/217 patients experienced reactivation of sarcoidosis and 29/217 patients experienced relapse of chronic disease).
RESULTS: Chitotriosidase was assessed as significant predictor of sarcoidosis activity. (AUROC=0.859; 95% Confidence Interval AUROC from 0.807 to 0.911; p<0.001), a cut point test value = 159.9 nmol/mL/h.). Sensitivity of chitotriosidase in patients with clinical signs of active sarcoidosis is 76.8%, while the reliability of chitotriosidase to exclude the disease activity in patients without clinical signs of diseases activity (specificity) was 90.4%. Logistic regression confirmed that patients with high serum chitotriosidase had likelihood of active disease comparing to patients with low serum chitotriosidase (odds ratio=18.06; Confidence Interval for odds ratio from 7.24 to 45.03; p<0.001). Logistic regression (classification of 88%) in groups active /not active sarcoidosis revealed the sensitivity for serum chitotriosidase test of 90.1% and specificity of 87.6%; (+) PV (predictive value) =88.6 and (-)PV=89.3.)
CONCLUSIONS: In sarcoidosis patients serum chitotriosidase levels > 159.9 nmol/mL/h reveal active disease in 90% of patients.
CLINICAL IMPLICATIONS: This recent study strongly supported the hypothesis that serum chitotriosidase could be a marker of sarcoidosis severity
DISCLOSURE: The following authors have nothing to disclose: Snezana Filipovic, Zorica Sumarac, Violeta Vucinic, Mira Vukovic, Jelica Videnovic, Vesna Skodric-Trifunovic, Mihailo Stjepanovic, Maja Omcikus
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