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Diagnostic Utility of Angiotensin-Converting Enzyme in Sarcoidosis: A Population-Based Study

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Abstract

Purpose

Sarcoidosis is a disease with heterogenous clinical presentations. Diagnosis of sarcoidosis is often challenging with the lack of gold standard tests. In this study, we investigated the diagnostic utility of angiotensin-converting enzyme (ACE) for diagnosis of sarcoidosis.

Methods

A cohort of Olmsted County, Minnesota residents who were diagnosed with sarcoidosis between January 1, 1984 and December 31, 2013 was identified based on individual medical record review. ACE levels recorded in the medical records of all subjects at the time of diagnosis were extracted. Comparator subjects were residents of Olmsted County, Minnesota who had ACE levels tested the same time period but did not have a diagnosis of sarcoidosis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the c-statistic of high versus low/normal ACE to diagnose sarcoidosis were calculated.

Results

A total of 3277 Olmsted County residents age ≥18 years had at least one ACE test in 1984–2013. The sarcoidosis incidence cohort contained 295 Olmsted County residents diagnosed with sarcoidosis in 1984–2013. Of these, ACE tests were obtained in 251. The sensitivity and specificity of high ACE for diagnosis of sarcoidosis were 41.4 % (95 % CI 35.3–47.8 %) and 89.9 % (95 % CI 88.8–91.0 %), respectively. The PPV and NPV in this population were 25.4 % (95 % CI 21.3–29.9 %) and 94.9 % (95 % CI 85.0–87.4 %).

Conclusions

This study demonstrated a poor sensitivity and insufficient specificity of high ACE for diagnosis of sarcoidosis suggesting a limited role of ACE in clinical practice.

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Funding

This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676 and CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First Avenue SW, Rochester, MN, 55905, USA

    Patompong Ungprasert, Cynthia S. Crowson & Eric L. Matteson

  2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Eva M. Carmona

  3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA

    Cynthia S. Crowson

  4. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA

    Eric L. Matteson

Authors
  1. Patompong Ungprasert
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  2. Eva M. Carmona
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  3. Cynthia S. Crowson
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  4. Eric L. Matteson
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Corresponding author

Correspondence to Patompong Ungprasert.

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We do not have any financial or non-financial potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ungprasert, P., Carmona, E.M., Crowson, C.S. et al. Diagnostic Utility of Angiotensin-Converting Enzyme in Sarcoidosis: A Population-Based Study. Lung 194, 91–95 (2016). https://doi.org/10.1007/s00408-015-9826-3

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  • DOI: https://doi.org/10.1007/s00408-015-9826-3

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