June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Predictive Value of Angiotensin Converting Enzyme, Soluble Interleukin-2 Receptor and Lysozyme for Pulmonary Involvement in Human Ocular Sarcoidosis
Author Affiliations & Notes
  • Rafael Grajewski
    Ophthalmology, University of Cologne, Cologne, Germany
  • Werner Adler
    Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
  • Konrad Frank
    Internal Medicine III, University of Cologne, Cologne, Germany
  • Mohamed Arfaoui
    Ophthalmology, University of Cologne, Cologne, Germany
  • Simona Schlereth
    Ophthalmology, University of Cologne, Cologne, Germany
  • Bernd Kirchhof
    Ophthalmology, University of Cologne, Cologne, Germany
  • Claus Cursiefen
    Ophthalmology, University of Cologne, Cologne, Germany
  • Ludwig Heindl
    Ophthalmology, University of Cologne, Cologne, Germany
  • Footnotes
    Commercial Relationships Rafael Grajewski, None; Werner Adler, None; Konrad Frank, None; Mohamed Arfaoui, None; Simona Schlereth, None; Bernd Kirchhof, None; Claus Cursiefen, Gene Signal (C), Alcon (R), Allergan (R), Bayer (R); Ludwig Heindl, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 5206. doi:https://doi.org/
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      Rafael Grajewski, Werner Adler, Konrad Frank, Mohamed Arfaoui, Simona Schlereth, Bernd Kirchhof, Claus Cursiefen, Ludwig Heindl; Predictive Value of Angiotensin Converting Enzyme, Soluble Interleukin-2 Receptor and Lysozyme for Pulmonary Involvement in Human Ocular Sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5206. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Sarcoidosis is an important cause of intraocular inflammation (uveitis) with very variable clinical presentation. Therefore, it is a clinical diagnosis that has to be supported by laboratory testing (pathology and serology).The most commonly used serological marker is angiotensin converting enzyme (ACE). In this study we analyzed additional markers (lysozyme and soluble Interleukin-2 Receptor: sIL-2R) that are associated with sarcoidosis and compared their single and combined values to predict pulmonary involvement that can confirm the diagnosis of ocular sarcoidosis.

Methods: ACE, lysozyme and sIL-2Rlevels have been determined in the serum of patients with noninfectious uveitis that was compatible with sarcoidosis. Patients (n=36) with elevation of at least one parameter have been classified according to the diagnostic criteria from the International Workshop on Ocular Sarcoidosis, Tokyo, 2006. Patients were further subdivided into groups with pulmonary involvement (biopsy proven: n=10, hilar lymphadenopathy: n=2) or without (n=24). Sensitivity, specificity and Youden index have been calculated to predict pulmonary sarcoidosis of single and combined serological values. None of the patients had been treated with ACE-inhibitors or systemic steroids.

Results: ACE as a single parameter revealed a lower sensitivity (0.50) than sIL-2R (0.83) or lysozyme (0.83), whereas the specificity was higher in ACE alone (0.88) than in sIL-2R (0.54) or lysozyme (0.50). The combination of ACE and sIL-2R demonstrated the highest Youden index (0.46) with a sensitivity of 0.50 and a specificity of 0.96, followed by the combination of ACE, sIL-2R and lysozyme (Youden index 0.42, sensitivity 0.42, specificity 1.00). Lysozyme combined with sIL-2R showed a Youden index of 0.38, a sensitivity of 0.67, and a specificity of 0.71, better than both values alone.

Conclusions: In contrast to the current practice with testing for ACE as a single marker, we propose a combination of ACE and sIL-2R as the standard serology to screen for sarcoidosis in uveitis patients. In patients that take ACE-inhibitors, ACE should be replaced by lysozyme. The combination of ACE and sIL-2R is the most reliable predictor of pulmonary involvement in ocular sarcoidosis.

Keywords: 557 inflammation • 467 clinical laboratory testing  
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