Sarcoidosis Diagnostic Score Enhances Disease Diagnosis

The use of a Sarcoidosis Diagnostic Score (SDS) that standardized the reporting of clinical manifestations enabled clinicians to determine the likelihood of sarcoidosis developing by summarizing disease characteristics of affected patients, according to the results of an analysis published in CHEST.

Data from a group of people with biopsy-confirmed sarcoidosis who were seen during a 7-month period at the University of Cincinnati Sarcoidosis Clinic were identified prospectively and compared with data from a group of individuals who did not have sarcoidosis and served as controls. With use of the World Association of Sarcoidosis and Other Granulomatous disease organ assessment instrument, all individuals were scored for the presence of biopsy, ≥1 highly probable symptom of the disease, and ≥1 at least probable symptom for each area. There were 2 sarcoidosis scores generated: SDS biopsy (ie, with biopsy) and SDS clinical (ie, without biopsy).

A total of 980 evaluable patients were divided into 2 cohorts: an initial 600 patients (450 with biopsy-confirmed sarcoidosis and 150 controls) to establish cut off values for SDS biopsy and SDS clinical and a validation cohort of 380 patients (103 with biopsy-confirmed sarcoidosis and 277 controls). The best cut off value for SDS biopsy was ≥6, with a sensitivity of 99.3% and a specificity of 100%. 

Of the total 980 participants, an SDS clinical score of ≥3 yielded a sensitivity of 94.2%, a specificity of 88.8%, and a likelihood ratio of 7.9. Furthermore, an SDS clinical score of ≥4 was associated with a lower sensitivity of 76.9% but a higher specificity of 98.6%.

The investigators concluded that in patients with sarcoidosis, the presence of certain clinical features, particularly multi-organ involvement, can greatly improve diagnostic certainty. The SDS scoring system demonstrated the ability to quantify the clinical characteristics that are consistent with a diagnosis of sarcoidosis. The SDS clinical score is based on clinical features alone, whereas the SDS biopsy score adds the information from biopsies, and therefore can help lead to a more specific diagnosis of the disease.

Reference

Bickett AN, Lower EE, Baughman RP. Sarcoidosis diagnostic score (SDS): a systematic evaluation to enhance the diagnosis of sarcoidosis [published online May 17, 2018]. Chest. doi:10.1016/j.chest.2018.05.003.