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Identification of Active Sarcoidosis Using Chitotriosidase and Angiotensin-Converting Enzyme

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Abstract

Purpose

Activity/remission differentiation is a great challenge in the follow-up and treatment of sarcoidosis patients. Angiotensin-converting enzyme (ACE) and high sensitivity C-reactive protein (hs-CRP) were proposed as sarcoidosis biomarkers. More recently, chitotriosidase (CHITO) has been described as a better alternative. This study has the aim to evaluate the association of CHITO activity, ACE, hs-CRP or a combination of these biomarkers and to construct a clinical algorithm to differentiate between sarcoidosis activity/remission status.

Methods

Forty-six patients with either active sarcoidosis or sarcoidosis in remission and 21 healthy individuals were included. ACE, hs-CRP, and CHITO were evaluated in serum samples. Comparisons of the laboratory variable means among groups were performed by linear models. The cutoff points of the biomarkers for activity/remission differentiation were calculated using the Youden’s index. Biomarker cutoff points and decision tree classifier (DTC) performance were estimated by their leave-one-out cross-validation (LOOCV) accuracy (Acc), sensitivity (Se), and specificity (Sp).

Results

A 55% mean Se and a 100% mean Sp were found for CHITO, while an 88% Se and a 47% Sp were found for ACE, and a 66% Se and a 68% Sp for hs-CRP cutoff points for activity/remission differentiation. The DTC algorithm with CHITO, hs-CRP, and ACE information had an LOOCV mean Acc of 82%, Se of 78%, and Sp of 89% for sarcoidosis activity/remission differentiation.

Conclusions

The algorithm involving CHITO, hs-CRP, and ACE could be a suitable strategy for differentiation between sarcoidosis activity/remission status.

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Funding

This study was supported by FAPERJ.

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Authors and Affiliations

  1. State University of Rio de Janeiro, Boulevard 28 de Setembro, 77 – Vila Isabel, 2nd floor - Pulmonology Service, Rio de Janeiro, RJ, 20551-030, Brazil

    Mariana Carneiro Lopes, Thaís Porto Amadeu, Claudia Henrique da Costa, Luciana Silva Rodrigues, Elisabeth Jauhar Cardoso Bessa, Leonardo Palermo Bruno, Agnaldo José Lopes & Rogerio Rufino

  2. National Institute of Infectology Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    Marcelo Ribeiro-Alves

Authors
  1. Mariana Carneiro Lopes
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  2. Thaís Porto Amadeu
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  3. Marcelo Ribeiro-Alves
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  4. Claudia Henrique da Costa
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  5. Luciana Silva Rodrigues
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  6. Elisabeth Jauhar Cardoso Bessa
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  7. Leonardo Palermo Bruno
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  8. Agnaldo José Lopes
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  9. Rogerio Rufino
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Corresponding author

Correspondence to Rogerio Rufino.

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Ethical approval

This project was approved by the research ethics committee (Protocol No. 1158044).

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Informed consent was obtained from all participants included in this study.

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Lopes, M.C., Amadeu, T.P., Ribeiro-Alves, M. et al. Identification of Active Sarcoidosis Using Chitotriosidase and Angiotensin-Converting Enzyme. Lung 197, 295–302 (2019). https://doi.org/10.1007/s00408-019-00219-2

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  • DOI: https://doi.org/10.1007/s00408-019-00219-2

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