Atrial Fibrillation, Heart Failure, and PH Increase Mortality Risk in Sarcoidosis

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

Patients with sarcoidosis have an increased risk of in-hospital mortality if they present with heart failure (HF), atrial fibrillation (AF), or pulmonary hypertension (PH), according to study results intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

Researchers from the Rutgers New Jersey School of Medicine in Newark examined rates of inpatient mortality in patients with sarcoidosis who had hospitalization data recorded in the National Inpatient Sample (NIS) database between 2000 and 2014. A total of 201,791 hospitalizations with a primary diagnosis of sarcoidosis during this time frame were identified in the database. Univariate and multivariate logistic regression models were used to evaluate the association between inpatient mortality and AF, atrial flutter (AFL), HF, hypertension, and PH and in these patients.

The mean age of the NIS sample was 55.7 years. At time of hospitalization, approximately 41% of patients had hypertension, 17.8% had HF, 9.1% had AF, 1.3% had AFL, and 0.4% had PAH. Overall, the mortality rate was 2.3%. In the multivariate analysis that compared patients with vs without sarcoidosis, significantly higher mortality rates were observed in patients with sarcoidosis and HF (odds ratio [OR], 1.34; 95% CI, 1.25-1.43), AF (OR, 1.46; 95% CI, 1.34-1.60), and PH (OR, 1.96; 95% CI, 1.44-2.66). Inpatient mortality was not affected by AFL (OR, 1.16; 95% CI, 0.95-1.43) in patients with sarcoidosis. Conversely, the investigators found a decreased mortality rate in patients with sarcoidosis and hypertension (OR, 0.50; 95% CI, 0.47-0.54). They noted that this finding warrants further investigation.

Limitations of the study included the retrospective design as well as the “transversal nature” of the NIS database.

The investigators concluded that HF, AF, and PAH “comorbidities may be markers of disease severity in patients with sarcoidosis.”

Reference

Nigri R, Roque W, Barajas-Ochoa A, Patel K, Ho J, Berman A. Cardiovascular diseases are associated with inpatient mortality in sarcoidosis. Am J Respir Crit Care Med. 2020;201:A1099.

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