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Clinical science
Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis
  1. Fahriye Groen-Hakan1,
  2. Laura Eurelings2,
  3. Aniki Rothova1,
  4. Jan van Laar2,3
  1. 1 Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Internal Medicine, Section Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
  3. 3 Department of Immunology, Laboratory Medical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Fahriye Groen-Hakan, Department of Ophthalmology, Erasmus University Medical Center, Rotterdam 3015 , The Netherlands; f.groen{at}erasmusmc.nl

Abstract

Background/aims The diagnostic properties of conventional diagnostic tests (ACE and chest radiography) for sarcoidosis-associated uveitis are not ideal. The diagnostic value of lymphopaenia for sarcoidosis-associated uveitis is investigated.

Methods A retrospective study of 191 consecutive patients with a first uveitis episode visiting the ophthalmology department (Erasmus Medical Center, Rotterdam, The Netherlands). Receiver operating characteristics (ROC) analysis was performed and compared with known ROC values from literature of conventional diagnostic tests for sarcoidosis-associated uveitis. An ideal cut-off was determined for lymphopaenia by calculation of the highest Youden index.

Results Out of all patients with first uveitis attack, 32/191 or 17% were subsequently diagnosed with biopsy-proven or radiological diagnosis of sarcoidosis. Lymphopaenia (<1.5×109/L) was significantly more often observed in patients with sarcoidosis-associated uveitis compared with patients with non-sarcoidosis-associated uveitis (p<0.05). The sensitivity and specificity of lymphopaenia was 75 % and 77 %, respectively. The optimal cut-off for lymphopaenia for diagnosing sarcoidosis-associated uveitis was 1.47 ×109/L. Lymphopaenia resulted in a 12.0 (95% CI 4.7 to 30.5 fold risk for having sarcoidosis, corrected for sex, race and age at onset of uveitis in patients with a first uveitis attack.

Conclusion Lymphopaenia is a non-invasive and useful marker for diagnosing sarcoidosis-associated uveitis.

  • inflammation
  • immunology
  • epidemiology

https://doi.org/10.1136/bjophthalmol-2018-313212

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    Footnotes

    • FG-H and LE are joint first authors.

    • Contributors Design of the study (FG-H and AR), conducting the study, data collection, data management (FG), data analysis, interpretation of the data and preparation, review of the manuscript (FG-H, AR and JvL). FG-H and LE contributed equally to this manuscript and should be considered first authors.

    • Funding This study was in part financially supported by AbbVie, The Netherlands.

    • Disclaimer The sponsor had no role in study design, in the collection, analysis and interpretation of data nor in the writing of the report and in the decision to submit the article for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The Erasmus Medical Centrel Medical Ethics Committee reviewed and approved the biobanking protocol and associated procedures this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available on request from the corresponding author: f.groen@erasmusmc.nl.