Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel.
Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
Medicina (Kaunas). 2024 Nov 1;60(11):1787. doi: 10.3390/medicina60111787.
Sarcoidosis, marked by chronic inflammation and granuloma formation, shows a variable clinical course. While many patients have benign outcomes, others face chronic, life-threatening complications. Mortality studies in sarcoidosis show mixed results due to age, ethnicity, sex, and geography, highlighting the need for a comprehensive mortality risk analysis. This study compares mortality risks between sarcoidosis patients and controls, considering demographic and clinical factors, and performs subgroup analyses across different age groups and post-diagnosis periods. This is a retrospective cohort study that used Clalit Health Services' electronic database, including patients first diagnosed with sarcoidosis from 2000 to 2016 and age- and sex-matched controls at a 1:5 ratio. Hazard ratios (HR) for all-cause mortality were obtained using the Cox proportional hazard model, adjusted for sociodemographic and clinical variables. Sarcoidosis patients showed higher mortality rates (17.7%) than controls (10.6%), with an adjusted HR of 1.79 (95% CI: 1.64-1.96, < 0.001). Subgroup analysis revealed the HR for mortality decreased with age: HR for patients under 50 was 3.04 (95% CI: 2.20-4.21), and for those over 70, it was 1.8 (95% CI: 1.69-2.11). The HR was highest in the first year post-diagnosis. Key mortality predictors included age at diagnosis, male gender, and higher Charlson comorbidity index score. Sarcoidosis patients, particularly younger ones and those with higher comorbidity burdens, have elevated mortality risks compared to controls, with the highest HR in the first year post-diagnosis. These findings highlight the most vulnerable period of the disease.
结节病以慢性炎症和肉芽肿形成为特征，表现出多变的临床过程。虽然许多患者有良性结局，但其他患者则面临慢性、危及生命的并发症。结节病的死亡率研究由于年龄、种族、性别和地理位置的不同，结果参差不齐，这突出表明需要进行全面的死亡率风险分析。本研究通过考虑人口统计学和临床因素，比较了结节病患者和对照组的死亡率风险，并在不同年龄组和诊断后时期进行了亚组分析。 这是一项回顾性队列研究，使用 Clalit 健康服务的电子数据库，包括 2000 年至 2016 年间首次被诊断为结节病的患者和年龄、性别匹配的对照组，比例为 1:5。使用 Cox 比例风险模型获得全因死亡率的风险比（HR），并根据社会人口统计学和临床变量进行调整。 与对照组（10.6%）相比，结节病患者的死亡率更高（17.7%），调整后的 HR 为 1.79（95%CI：1.64-1.96，<0.001）。亚组分析显示，死亡率的 HR 随年龄而降低：50 岁以下患者的 HR 为 3.04（95%CI：2.20-4.21），70 岁以上患者的 HR 为 1.8（95%CI：1.69-2.11）。诊断后第一年的 HR 最高。关键死亡预测因素包括诊断时的年龄、性别和更高的 Charlson 合并症指数评分。 与对照组相比，结节病患者，特别是年龄较小和合并症负担较高的患者，死亡率风险升高，诊断后第一年的 HR 最高。这些发现突出了疾病最脆弱的时期。
