Skip to main content
SpringerLink
Log in

The Relationship Between Serum Angiotensin Converting Enzyme Level and the Decision to Escalate Treatment of Sarcoidosis

  • SARCOIDOSIS
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

We performed a retrospective analysis of a sarcoidosis cohort who had sACE obtained at their initial clinic visit, but the treating physician was blinded to the results. We examined the relationship between sACE and the treating physician’s decision to escalate sarcoidosis treatment.

Methods

Treatment was considered escalated if the prednisone dose was increased or if the prednisone dose was not changed but an additional anti-sarcoidosis drug was added or the dose was increased.

Results

561 sarcoidosis patients were analyzed. The most common target organ was the lung (84%). Using a cut-off of > 82 units/L for an elevated sACE, 31/82 (38%) with an elevated sACE had treatment escalation whereas 91/497 (18%) had treatment escalation with a normal sACE (p < 0.0001). For the need of treatment escalation, a sACE (cut-off of > 82) had sensitivity 0.25, specificity 0.89, positive predictive value 0.38, negative predictive value 0.81. These results were not appreciably different using other sACE cut-off values such as 70, 80, 90, or 100. A multivariable logistic regression model that included demographics, the target organ, spirometry results estimated that sACE level and lower FVC were significantly associated with the likelihood of treatment escalation. These findings held when sACE > 82 replaced sACE level in the multivariable logistic regression model.

Conclusions

Although there was a strong correlation between sACE at the initial sarcoidosis clinic visit and subsequent treatment escalation of sarcoidosis, the predictive power was such that sACE is not adequately reliable to be used in isolation to make this determination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shen XZ, Billet S, Lin C et al (2011) The carboxypeptidase ACE shapes the MHC class I peptide repertoire. Nat Immunol 12(11):1078–1085

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Sheffield EA (1997) Pathology of sarcoidosis. Clin Chest Med 18(4):741–754

    Article  CAS  PubMed  Google Scholar 

  3. Lynch JP 3rd, Kazerooni EA, Gay SE (1997) Pulmonary sarcoidosis. Clin Chest Med 18(4):755–785

    Article  PubMed  Google Scholar 

  4. Chopra A, Kalkanis A, Judson MA (2016) Biomarkers in sarcoidosis. Expert Rev Clin Immunol 12(11):1191–1208

    Article  CAS  PubMed  Google Scholar 

  5. Finkel R, Teirstein AS, Levine R, Brown LK, Miller A (1986) Pulmonary function tests, serum angiotensin-converting enzyme levels, and clinical findings as prognostic indicators in sarcoidosis. Ann N Y Acad Sci 465:665–671

    Article  CAS  PubMed  Google Scholar 

  6. Crouser ED, Maier LA, Wilson KC et al (2020) Diagnosis and detection of sarcoidosis: an official american thoracic society clinical practice guideline. Am J Respir Crit Care Med 201(8):e26–e51

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 159(1):179–187

    Article  CAS  PubMed  Google Scholar 

  8. Klech H, Kohn H, Kummer F, Mostbeck A (1982) Assessment of activity in sarcoidosis: sensitivity and specificity of 67Gallium scintigraphy, serum ACE levels, chest roentgenography, and blood lymphocyte subpopulations. Chest 82(6):732–738

    Article  CAS  PubMed  Google Scholar 

  9. Selroos OB (1984) Value of biochemical markers in serum for determination of disease activity in sarcoidosis. Sarcoidosis 1(1):45–49

    CAS  PubMed  Google Scholar 

  10. Selroos OB (1986) Biochemical markers in sarcoidosis. Crit Rev Clin Lab Sci 24(3):185–216

    Article  CAS  PubMed  Google Scholar 

  11. Teirstein AS, Judson MA, Baughman RP, Rossman MD, Yeager H Jr, Moller DR (2005) The spectrum of biopsy sites for the diagnosis of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 22(2):139–146

    PubMed  Google Scholar 

  12. Vorselaars AD, van Moorsel CH, Zanen P et al (2015) ACE and sIL-2R correlate with lung function improvement in sarcoidosis during methotrexate therapy. Respir Med 109(2):279–285

    Article  PubMed  Google Scholar 

  13. Lieberman J, Sastre A (1980) Serum angiotensin-converting enzyme: elevations in diabetes mellitus. Ann Intern Med 93(6):825–826

    Article  CAS  PubMed  Google Scholar 

  14. DeRemee RA, Rohrbach MS (1980) Serum angiotensin-converting enzyme activity in evaluating the clinical course of sarcoidosis. Ann Intern Med 92(3):361–365

    Article  CAS  PubMed  Google Scholar 

  15. Cohen RD, Bunting PS, Meindok HO, Chamberlain DW, Rebuck AS (1985) Does serum angiotensin converting enzyme reflect intensity of alveolitis in sarcoidosis? Thorax 40(7):497–500

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Rust M, Bergmann L, Kuhn T et al (1985) Prognostic value of chest radiograph, serum-angiotensin-converting enzyme and T helper cell count in blood and in bronchoalveolar lavage of patients with pulmonary sarcoidosis. Respir Int Rev Thoracic Dis 48(3):231–236

    CAS  Google Scholar 

  17. Baughman RP, Fernandez M, Bosken CH, Mantil J, Hurtubise P (1984) Comparison of gallium-67 scanning, bronchoalveolar lavage, and serum angiotensin-converting enzyme levels in pulmonary sarcoidosis: predicting response to therapy. Am Rev Respir Dis 129(5):676–681

    Article  CAS  PubMed  Google Scholar 

  18. Baughman RP, Ploysongsang Y, Roberts RD, Srivastava L (1983) Effects of sarcoid and steroids on angiotensin-converting enzyme. Am Rev Respir Dis 128(4):631–633

    CAS  PubMed  Google Scholar 

  19. Snider GL (1985) Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis. Am Rev Respir Dis 132(5):1139–1140

    CAS  PubMed  Google Scholar 

  20. Hollinger WM, Staton GW Jr, Fajman WA, Gilman MJ, Pine JR, Check IJ (1985) Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis: evaluation of clinical parameters, bronchoalveolar lavage, gallium-67 lung scanning, and serum angiotensin-converting enzyme levels. Am Rev Respir Dis 132(1):65–69

    CAS  PubMed  Google Scholar 

  21. Baughman RP, Valeyre D, Korsten P et al (2021) ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J 58(6):158

    Article  Google Scholar 

  22. Kobayashi Y, Sato T, Nagai T et al (2021) Association of high serum soluble interleukin 2 receptor levels with risk of adverse events in cardiac sarcoidosis. ESC Heart Fail 8(6):5282–5292

    Article  PubMed Central  PubMed  Google Scholar 

  23. Bennett D, Cameli P, Lanzarone N et al (2020) Chitotriosidase: a biomarker of activity and severity in patients with sarcoidosis. Respir Res 21(1):6

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Bergantini L, Bianchi F, Cameli P et al (2019) Prognostic biomarkers of sarcoidosis: a comparative study of serum chitotriosidase, ACE, lysozyme, and KL-6. Dis Markers 2019:8565423

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge Sooyeon-Kwon, PhD for her assistance with manuscript tables and her guidance.

Funding

There was no funding for this research.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Pulmonary and Critical Care Medicine MC-91, Albany Medical College, 16 New Scotland Avenue, Albany, NY, 12208, USA

    Boris Shkolnik, Muhammad Salick, Gowthami Kobbari, Sana Ghalib, Anoosh S. Parimi, Kenneth M. Fish, Robert Deluca & Marc A. Judson

  2. Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA

    Rou Sore & Recai Yucel

Authors
  1. Boris Shkolnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rou Sore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammad Salick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gowthami Kobbari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sana Ghalib
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anoosh S. Parimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenneth M. Fish
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert Deluca
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Recai Yucel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marc A. Judson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BS: Assisted in study design, data collection, writing and editing of the manuscript. RS: Statistical analysis, writing and editing the manuscript. MS: Data collection, writing and editing the manuscript. GK: Data collection, writing and editing the manuscript. SG: Data collection, writing and editing the manuscript. GK: Data collection, writing and editing the manuscript. ASP: Data collection, writing and editing the manuscript. GK: Data collection, writing and editing the manuscript. KMF: Assisted with data management and statistical analysis. RD: Assisted with data management and statistical analysis. RY: Statistical analysis, writing and editing the manuscript. MAJ: Study design; data collection, assisted in statistical analysis, writing and editing the manuscript.

Corresponding author

Correspondence to Marc A. Judson.

Ethics declarations

Conflict of interest

MAJ: Consultant for Prometheus; Star Therapeutics; has received grants for his institution from Mallinckrodt, aTyr Pharmaceuticals, and Foundation for Sarcoidosis Research. No other author has any competing interests.

Ethical Approval

This study was approved by the Albany Medical Center Institutional Review Board (study number 6272).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 34 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shkolnik, B., Sore, R., Salick, M. et al. The Relationship Between Serum Angiotensin Converting Enzyme Level and the Decision to Escalate Treatment of Sarcoidosis. Lung 201, 381–386 (2023). https://doi.org/10.1007/s00408-023-00629-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-023-00629-3

Keywords

Search

Navigation