Most deaths in hospitalized sarcoidosis patients linked to other causes
Study findings highlight infections, cardiovascular disease, and cancer
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While sarcoidosis can lead to hospital admission, in-hospital deaths among people with sarcoidosis are most often caused by other conditions rather than the disease itself, according to a real-world national study in Spain.
Common causes of death included infections, cardiovascular disease, cancer, and blood clots known as venous thromboembolism (VTE).
The findings highlight how “prevention of infections, VTE, and [cancer], along with control of cardiovascular risk factors, may help reduce mortality in these patients,” the researchers wrote.
Study examines hospital admissions and mortality in sarcoidosis
The study, “Impact of comorbidities and organ damage on hospital admissions and mortality in patients with sarcoidosis: an observational study from the Spanish National Registry,” was published in Internal and Emergency Medicine.
Sarcoidosis is an inflammatory disease marked by the formation of abnormal clumps of immune cells, called granulomas, in different organs of the body. It most often affects the lungs, but can also involve other organs, including the lymph nodes (structures that help support the immune system), skin, eyes, and heart.
Disease outcomes can vary widely from person to person. In some cases, sarcoidosis resolves on its own, while in others it becomes chronic and can lead to scarring (fibrosis) and lasting organ damage.
About 10% to 30% of people develop more severe forms of the disease, which can involve chronic inflammation, fibrosis, or organ damage. Sarcoidosis has also been linked to a higher risk of complications such as infections, cardiovascular disease, cancer, and VTE. VTE occurs when blood clots form in the deep veins of the legs, groin, or arms and block blood flow.
Researchers analyze national hospital data in Spain
Given these risks, a team of researchers in Spain set out to better understand the factors linked to hospitalization and death among people with sarcoidosis. To do this, they conducted a retrospective analysis using data from the Spanish National Hospital Discharge Database, examining hospital admissions involving sarcoidosis between 2016 and 2021.
In total, the analysis included 18,887 hospital admissions involving people with sarcoidosis. Among these admissions, patients were most commonly Caucasian (76.6%) and women (53.1%), with a mean age of 62 years.
The lungs were by far the most commonly affected organ, with pulmonary sarcoidosis noted in 45% of hospitalized patients. Involvement of other organs and systems — including the lymph nodes, skin, heart, kidneys, and eyes — was much less frequent.
Many patients also had other co-occurring health conditions (comorbidities), most commonly diabetes (27.6%), chronic lung disease (23.8%), heart failure (23.1%), and chronic kidney disease (14.7%).
Hospital stays lasted a mean of 8.6 days, and 5.9% of patients required intensive care. Overall, 892 hospital admissions (4.7%) resulted in death during the hospital stay. Among those who died, more than half (52.1%) were women, and the mean age was 72.9 years.
Infections are leading cause of admission and death
The most common reason for hospital admission was infections (21%), followed by sarcoidosis itself (16.4%), cardiovascular disease (12.7%), and cancer (7.1%). Participants admitted due to sarcoidosis were significantly younger (54 years vs. 64.7 years) and had significantly fewer or less severe comorbidities than those hospitalized for other reasons.
Infections were the leading cause of death among hospitalized sarcoidosis patients (32.1%), followed by cardiovascular disease (16.3%) and cancer (12.4%). These conditions were associated with in-hospital fatality rates of about 6% to more than 8%.
Although VTE accounted for only 1.6% of deaths, it carried a relatively high case fatality rate of 6.6%, despite being uncommon among hospitalized patients.
Sarcoidosis itself was the direct cause of death in 7.6% of cases and was associated with a relatively low case fatality rate of 2.2%.
“Greater knowledge of the disease, early diagnosis, and timely initiation of immunosuppressive treatment when indicated may explain the lower mortality directly related to sarcoidosis activity,” the researchers wrote. “However, chronic inflammation, increased comorbidities, and immunosuppressive therapy likely contribute to higher mortality from infections, [cardiovascular disease], and [cancer].”
Several factors associated with higher risk
Statistical analyses showed that several factors were independently associated with a higher risk of dying in the hospital among people with sarcoidosis.
Admission due to infections was the most significant risk factor, more than doubling the risk, followed by lung fibrosis and admission due to VTE, both of which were significantly associated with about a twofold higher risk.
Admission due to cancer was linked to a 77% higher risk of death, while admission due to cardiovascular disease was associated with a 56% higher risk. Having more or more severe comorbidities was linked to a 30% higher risk of death, and having pulmonary sarcoidosis without fibrosis increased the risk by about 20%.
Risk factors differed among patients who died due to sarcoidosis itself. These included being male and having pulmonary sarcoidosis — linked to a 1.67 to twofold higher risk — as well as having lung fibrosis and involvement of the central nervous system, each associated with more than a fivefold higher risk.
“Preventive measures—such as up-to-date vaccination schedules, appropriate management and control of cardiovascular risk factors, prevention and monitoring of VTE, and cancer screening programs, may help reduce mortality in this population,” the researchers concluded.
