Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics.
Pulmonary hypertension (PH) is a predictor of poor outcome in sarcoidosis. Little is known about the epidemiology of PH in sarcoidosis. The current authors reviewed the records of patients with sarcoidosis listed for lung transplantation in the USA between January 1995 and December 2002. PH was defined as a mean pulmonary artery pressure of >25 mmHg and severe PH as a mean pulmonary artery pressure of > or =40 mmHg. The cohort included 363 patients of whom 73.8% had PH. Neither spirometric testing nor the need for corticosteroids was associated with PH. Subjects with PH required more supplemental oxygen (2.7+/-1.8 L.min(-1) versus 1.6+/-1.4 L.min(-1)). The cardiac index was lower in individuals with PH, whereas the pulmonary capillary wedge pressure was higher. In multivariate analysis, supplemental oxygen remained an independent predictor of PH, whereas the relationship between cardiac index and PH was no longer significant. As a screening test, the need for oxygen had a sensitivity and specificity of 91.8% and 32.6%, respectively. Pulmonary hypertension is common in advanced sarcoidosis. The need for oxygen correlates with pulmonary hypertension. Since pulmonary hypertension is associated with poor outcomes and because simple clinical criteria fail to identify patients with sarcoidosis and pulmonary hypertension, more aggressive screening for this should be considered.
Shorr
A F
AF
The Pulomonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA. afshorr@dnamail.com
Helman
D L
DL
Davies
D B
DB
Nathan
S D
SD
D001741:Black or African American / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012507:Sarcoidosis / Q000175:diagnosis* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data