PO1 - Sex-based phenotypic differences and outcomes in sarcoidosis: data from the SARCO-I Spanish multicentre registry
Juan Jose Zapata Huizi (Spain)1; Joel Francesqui (Spain)2; Daniel Ramos (Spain)3; Elena Bollo de Miguel (Spain)4; Ana Villar Gomez (Spain)5; Pablo Flórez Solarana (Spain)6; Eva Balcells Vilarnau (Spain)7; Gema Castaño (Spain)8; Erwin Pinillos Robles (Spain)9; Raul Godoy Mayoral (Spain)10; Belén López Muñiz (Spain)11; María José Soler-Sampere (Spain)12; Diego Castillo (Spain)2; Albert Rafecas-Codern (Spain)2; Pablo Mariscal Aguilar (Spain)13; Luis Gomez Carrera (Spain)13; Gema Bonilla (Spain)14; Paloma Millan Pilli (Spain)15; Karina Portillo (Spain)15; Fernanda Hernández-González (Spain)1; Jacobo Sellares (Spain)1;
1 - Sarcoidosis Unit, Pulmonology Department, Respiratory Clinical Institute, Hospital Clinic, Barcelona, Spain; 2 - Department of Respiratory Medicine and Allergy, Hospital de la Santa Creu i Sant Pau. Institut de Recerca Sant Pau (IR SANT PAU). Barcelona, Spain; 3 - Instituto Nacional del Tórax, Santiago, Chile; 4 - Department of Pulmonology, Complejo Asistencial Universitario de León, León, Spain.; 5 - Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; 6 - Pulmonology Department, Corporació Sanitari Parc Taulí, Sabadell, Spain.; 7 - Hospital del Mar, Barcelona, Spain.; 8 - Hospital de Jarrio, Asturias, Spain.; 9 - Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain.; 10 - Pulmonology Department. Hospital Universitario de Albacete, Spain.; 11 - Hospital Infanta Leonor, Madrid, Spain.; 12 - Hospital General Universitario de Elche, Alicante, Spain.; 13 - Hospital Universitario La Paz, Madrid, Spain.; 14 - Servicio de Reumatología, Hospital Universitario La Paz; 15 - Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.;
Keywords: Sex-based; Phenotypic; Differences;
Select the theme: Challenges in Sarcoidosis Diagnosis and Staging
Type: Original Papers
Presentation: Poster Presentation

Introduction: Sex may influence sarcoidosis clinical phenotype and long-term prognosis, but large cohort data are scarce.

Objectives: To characterize sex-based differences in clinical presentation, pulmonary function, treatment, and outcomes in a multicenter Spanish cohort.

Materials and Methods: Retrospective multicenter analysis from the SARCO-I Spanish pulmonary sarcoidosis cohort, including 765 patients diagnosed according to 1999 WASOG criteria from 13 hospitals. Demographic, clinical, radiological, functional, and comorbidity data were compared between sexes.

Results: Of 765 patients, 323 (42%) were male and 442 (58%) female. Males were diagnosed younger (45 ± 13 vs 50 ± 15 years; p<0.001). Males presented with more advanced radiological disease (Scadding IV: 7.1% vs 4.3%), while females more frequently had Stage 0–I (41.4% vs 33.1%) and cutaneous involvement (33.3% vs 18.0%; p<0.001). At diagnosis, males had worse lung function (FVC% 89.7 ± 19.6 vs 93.4 ± 19.2; p=0.046; FEV1% 85.8 ± 20.5 vs 90.2 ± 19.3; p=0.020). Comorbidity burden was similar between sexes (cardiovascular: 8.4% vs 10.2%, p=0.47; respiratory: 14.2% vs 13.1%, p=0.73). Oral corticosteroid use was similar (51.7% vs 49.8%; p=0.65) and CT progression rates at any timepoint during follow-up were comparable (18.6% vs 15.2%; p=0.25). Despite their milder functional and radiological profile, crude 5-year mortality was higher in females (7.2% vs 3.4%; p=0.034). 

Conclusions: Male and female sarcoidosis patients present with distinct phenotypes: males show more advanced radiological and functional impairment, while females present with more cutaneous involvement and milder radiological disease. Despite similar treatment intensity and comorbidity burden, females show higher crude 5-year mortality, consistent with their older age at diagnosis, a recognized independent predictor of sarcoidosis mortality in this cohort. These findings highlight the importance of sex-aware clinical assessment and age-adjusted risk stratification in sarcoidosis.