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Factores de riesgo de recaída de la sarcoidosis: un análisis de clúster retrospectivo unicéntrico
Francesco Bertuccio1,2, Davide Piloni2, Mariachiara Crescenzi1,2
1Respiratory Unit, IRCCS Policlinico San Matteo, Pavia, Italy.
BMJ open respiratory research
|February 9, 2026
Resumen
La recurrencia de la sarcoidosis está relacionada con el tabaquismo, la obesidad y la enfermedad avanzada. La identificación de subgrupos de pacientes puede personalizar el tratamiento y mejorar los resultados de esta enfermedad granulomatosa sistémica.
Área de la Ciencia:
- Neumología; Reumatología; Inmunología; Enfermedades Granulomatosas Sistémicas
Sus antecedentes:
- La sarcoidosis es una enfermedad granulomatosa sistémica con un curso clínico impredecible.
- Los corticosteroides son el tratamiento principal, pero la recurrencia es frecuente.
- La estratificación actual de pacientes para el riesgo de recurrencia de la sarcoidosis está subdesarrollada.
Objetivo del estudio:
- Identificar factores clínicos, demográficos y terapéuticos clave que influyen en la recurrencia de la sarcoidosis.
- Desarrollar un modelo integrado de estratificación de riesgos para mejorar el manejo de la sarcoidosis.
- Comprender los fenotipos de la sarcoidosis y su impacto en la recurrencia de la enfermedad.
Principales métodos:
- Análisis de clúster de 160 pacientes con sarcoidosis utilizando el algoritmo K-means.
- Variables analizadas: edad, sexo, IMC, antecedentes de tabaquismo, estadio de Scadding, uso de corticosteroides/inmunosupresores, duración de la terapia y recurrencia.
- Número óptimo de clústeres determinado por los métodos de silueta y codo.
Principales resultados:
- Se identificaron tres clústeres distintos de pacientes basados en el riesgo de recurrencia.
- Los predictores de recurrencia incluyeron tabaquismo, obesidad y uso prolongado de corticosteroides (>12 meses).
- Se observaron diferencias de sexo en la manifestación de la enfermedad (mujeres: extrapulmonar; hombres: fibrosis pulmonar), aunque no fueron un predictor significativo.
Conclusiones:
- Los fenotipos distintos de la sarcoidosis influyen significativamente en el riesgo de recurrencia, lo que requiere estrategias de manejo personalizadas.
- El tabaquismo, la obesidad y la enfermedad avanzada son impulsores clave de la recurrencia en clústeres de pacientes específicos.
- Las intervenciones dirigidas, como el cese del tabaquismo, el control del peso y las terapias tempranas que ahorran esteroides, pueden mejorar los resultados a largo plazo.
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