Abstract Introduction Sarcoidosis is a multisystemic disease most commonly affecting the lungs and additional organs. 2020 ATS guidelines recommend screening of select extrapulmonary organs at diagnosis ; longitudinal screening varies significantly and standard of care is unclear. Patient-specific factors and particulate matter less than 2.5μm (PM2.5) are associated with progressive pulmonary sarcoidosis, although their relationship with extrapulmonary manifestations are unknown, a focus of this study. Methods Using a Cox proportional hazard model, we retrospectively examined effects of sex, age at diagnosis, self-identified race and ethnicity, treatment, and smoking status on risk of developing new organ involvement after a sarcoidosis diagnosis. Time-to-event was calculated from diagnosis based on date of biopsy to date of first new organ involvement. Last office visit date was used for censoring if no new organ involvement was identified. Subgroup analysis was performed among those with new cardiac or ocular involvement. Secondary analysis evaluated PM2.5 exposure 3 years prior to enrollment and new organ involvement. PM2.5 was estimated using data from the Center for Air, Climate, & Energy Solutions between 2010-2020 and participants’ zip code at diagnosis. Results In the primary analysis (n = 1168), 167 participants (14%) had new organ involvement after an initial diagnosis of sarcoidosis while 1,001 (86%) did not. Any new organ involvement occurred median, 2,445 days after diagnosis, compared to median, 2,264 days for those without. Our model found age at diagnosis (HR 1.03, 95% CI 1.02-1.05), need for treatment (HR 1.76, 95% CI 1.28-2.42), and current smoking (HR 2.24, 95% CI 1.12-4.49, reference=non-smoker) associated with new organ involvement (Figure 1). Non-White/non-Black race met statistical significance (reference=white), yet the number of participants was small (n = 29). Age at diagnosis was associated with cardiac and ocular involvement in subgroup analysis (HR 1.04, 1.00-1.07). PM2.5 exposure was estimated in 246 participants but the association was not statistically significant (HR 1.01, 95% CI 0.85-1.20, p = 0.27). Discussion Diagnosis at a later age, current smoking, and need for treatment were associated with increased risk for sarcoidosis new organ involvement. Age at diagnosis remained significant in those with new cardiac or ocular involvement. Higher PM2.5 exposure prior to diagnosis did not show statistically significant association with new organ involvement but analysis was limited by small sample size and exposure estimates at the zip code level. Future efforts are needed to further define associations with longitudinal extrapulmonary manifestations, thereby informing our understanding of pathophysiology and personalizing follow-up care. This abstract is funded by: American Thoracic Society/Foundation for Sarcoidosis Research
Mallozzi et al. (Fri,) studied this question.