Gazengel Pierre, Hindre Raphael, Jeny Florence, Mendes Sharon, Caliez Julien, Freynet Olivia, Rotenberg Cecile, Didier Morgane, Dhote Robin, Cohen Yves, Uzunhan Yurdagul, Bouvry Diane, Nunes Hilario
Service de pneumologie, Centre de référence des maladies pulmonaires rares (site constitutif), hôpital Avicenne, Assistance Publique Hôpitaux de Paris, UMR Inserm U1272, Université Sorbonne Paris Nord, Bobigny, France.
Service de pneumologie, Centre de référence des maladies pulmonaires rares (site constitutif), hôpital Avicenne, Assistance Publique Hôpitaux de Paris, UMR Inserm U1272, Université Sorbonne Paris Nord, Bobigny, France.
Chest. 2025 Jan;167(1):164-171. doi: 10.1016/j.chest.2024.06.3839. Epub 2024 Aug 28.
Sarcoidosis is an idiopathic systemic granulomatosis whose evolution is self-limiting in most cases. However, it can progress to organ damage that menaces the vital or functional prognosis of patients. Sarcoidosis itself, but also its comorbidities, can pose a threat to the patient, require rapid initiation of treatment, and justify emergency hospitalization.
What are the reasons and prognosis of patients with sarcoidosis hospitalized in emergency?
The objectives of our study were to describe the causes of admission for and to identify predictors of mortality in patients with sarcoidosis hospitalized in emergency. This is a retrospective monocentric study. We included patients hospitalized after a stay in the ED or ICU, or requiring an unscheduled hospitalization after telephone advice or a consultation, between January 1, 2017, and July 7, 2020.
We identified 154 patients with sarcoidosis hospitalized in emergency, among which 14 (9%) required the ICU. There were 81 male patients, with a median age of 55.0 years (interquartile range, 44.0-67.0). Sarcoidosis was inaugural in 20 patients (14%). The primary reason for hospitalization was lower respiratory infections in 32 patients (21%), followed by acute pulmonary exacerbation of sarcoidosis in 17 (11%), suspected cardiac sarcoidosis in 13 (8.4%), and neurosarcoidosis in 12 (7.7%). The median length of stay was 6 days (interquartile range, 3.00-10.0). In-hospital mortality rate was 3.9%. The 2-year transplantation-free survival after hospitalization was 86.8% (95% CI, 81.4-92.5). The factors associated with a worse transplantation-free survival were Charlson Comorbidity Index score (hazard ratio [HR], 1.29; 95% CI, 1.04-1.61; P = .021), pulmonary hypertension (HR, 2.53; 95% CI, 1.10-5.83; P = .029), and oxygen therapy during hospitalization (HR, 4.18; 95% CI, 1.55-11.29; P = .005).
Our findings indicate that the overall mortality of patients with sarcoidosis hospitalized in emergency was high. The presence of comorbidities and the severity of respiratory failure, as reflected by oxygen requirement, are important prognostic determinants.
结节病是一种特发性全身性肉芽肿病，在大多数情况下其病程呈自限性。然而，它可进展为器官损害，危及患者的生命或功能预后。结节病本身及其合并症都可能对患者构成威胁，需要迅速开始治疗，并证明有紧急住院的必要。
结节病患者紧急住院的原因及预后如何？
我们研究的目的是描述结节病患者紧急住院的入院原因，并确定其死亡预测因素。这是一项回顾性单中心研究。我们纳入了2017年1月1日至2020年7月7日期间在急诊科或重症监护病房停留后住院，或经电话咨询或会诊后需要非计划住院的患者。
我们确定了154例结节病紧急住院患者，其中14例（9%）需要入住重症监护病房。有81例男性患者，中位年龄为55.0岁（四分位间距，44.0 - 67.0）。20例患者（14%）结节病为首发。住院的主要原因是32例患者（21%）发生下呼吸道感染，其次是17例（11%）结节病急性肺部加重，13例（8.4%）疑似心脏结节病，12例（7.7%）神经结节病。中位住院时间为6天（四分位间距，3.00 - 10.0）。住院死亡率为3.9%。住院后2年无移植生存率为86.8%（95%可信区间，81.4 - 92.5）。与较差的无移植生存率相关的因素有查尔森合并症指数评分（风险比[HR]，1.29；95%可信区间，1.04 - 1.61；P = 0.021）、肺动脉高压（HR，2.53；95%可信区间，1.10 - 5.83；P = 0.029）以及住院期间吸氧治疗（HR，4.18；95%可信区间，1.55 - 11.29；P = 0.005）。
我们的研究结果表明，结节病紧急住院患者的总体死亡率较高。合并症的存在以及吸氧需求所反映的呼吸衰竭严重程度是重要的预后决定因素。
