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    Escore Multidimensional Simples Para Predição Do Curso Clínico Da Sarcoidose Na Avaliação Inicial
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Castro, Marina Dornfeld Cunha [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is variable and is mainly related to persistent inflammation process and development of fibrosis. Prognostic features have been described, but there is no validated model to predict the evolution of the disease. Aim: To find predictive features associated to clinical course of sarcoidosis at initial evaluation and develop a predictive score. Methods: This was a retrospective study of a cohort of patients with diagnosis of sarcoidosis, followed in reference centers involved in interstitial lung disease. Clinical, radiographic and functional data were compared by univariate analysis between patients with limited course – spontaneous involution or stability after a course of therapy and persistent – relapse or resistance to treatment, persistent treatment or chronic stable disease. Data related to persistent disease were selected by multivariate analysis and a prognostic score was developed.Results: 200 patients were included. 63% were female. Mean age at diagnosis was 50 years old. Median of time of symptoms was 12 months. Early diagnosis was characterized by time of symptoms ≤ 12 months and was found in 57% of cases. Dyspnea and cough were the most common pulmonary symptoms. Treatment for tuberculosis was prescribed before diagnosis in 44 patients. The most common radiologic stage was II (lung parenchyma and thoracic adenopathy). Mean forced vital capacity (FVC) was 84.9 ± 18.8% of predicted, with 37% of the cases with FVC below lower limit of reference. Relevant systemic involvement was detected in 37% of the patients. During the evolution, 77% of the cases needed immunosuppressive treatment and the course of disease was classified as persistent in 115 cases. By logistic regression, excluding 40 patients with pulmonary fibrosis, the findings related to persistent disease were: parenchymal lung involvement [odds ratio (OR) 3.83], late diagnosis (OR 2.82), dyspnea (OR 2.80), systemic involvement (OR 2.55) and reduced FVC (OR 2.33). A score was developed, taking into account the weight of the variable (1 point each), with positive predictive value for persistent disease in A score (≤ 1 point) and C score (≥ 4 points) of 17% and 88% respectively. Conclusion: A predictive score for sarcoidosis outcome can be derived by multiple variables at initial evaluation, allowing prediction of the clinical course of disease in a significant number of cases. The results should be confirmed in a validation cohort.