Predictors of mortality in sarcoidosis: a nationwide cohort study from the SARCOGEAS registry

Sarcoidosis is a systemic granulomatous disorder with variable prognosis. Mortality arises from both organ-specific and demographic factors, but reliable baseline predictors remain incompletely defined. We aimed to describe long-term survival and causes of death, and to identify demographic, radiological, and clinical predictors of mortality in national cohort of patients with sarcoidosis.

Retrospective multicentre cohort study within the Spanish SARCOGEAS registry. Adults diagnosed according to the ATS/ERS/WASOG criteria were consecutively enrolled across 36 hospitals. Demographic, clinical, and radiological variables were collected at baseline, including pulmonary involvement classified by the Scadding Scale and extrapulmonary disease defined by the WASOG criteria. The primary outcome was all-cause mortality. Survival was estimated with Kaplan-Meier analysis, and predictors were assessed using Cox regression.

A total of 2,187 patients were included (48.6 ± 15.2 years; 61.4% women). Median follow-up was 5.93 years. Overall, 225 patients died (10.29%). Survival was 99.2% at 1 year, 88.3% at 10 years, 73.2% at 20 years. In multivariable Cox proportional hazards analysis, independent predictors of mortality were older age (HR 1.11, 95% CI 1.10-1.13), male sex (HR 1.75, 95% CI 1.31-2.35, p<0.001), Scadding stages II-IV (HRs 1.42-2.73), and cardiac involvement (HR 1.84, 95% CI 1.05-3.21, p=0.033). Extrathoracic lymphadenopathy was associated with lower risk (HR 0.63, 95% CI 0.43-0.91, p=0.016). Main causes of death were pulmonary (n=92, 40.9%), malignancies (n=47, 20.9%), extrapulmonary (n=39, 17.3%), cardiovascular (n=24, 10.7%), and other causes (n=23, 10.2%).

n this nationwide, multicentre cohort, mortality was 10.29%. Mortality was independently associated with age, male sex, cardiac and pulmonary parenchymal involvement, while extrathoracic lymphadenopathy was linked to lower mortality.