Get reliable laboratory findings – how to recognize the deceptive effects of angiotensin-converting enzyme inhibitor therapy in the laboratory diagnostics of sarcoidosis?

Author:

Szabó Attila Ádám12,Enyedi Enikő Edit12,Altorjay István Tibor23,Hajnal Péter12,Pintér Tamás Bence1,Mányiné Ivetta Siket1,Váradi Csongor4,Bányai Emese5,Tóth Attila1,Papp Zoltán1,Fagyas Miklós1ORCID

Affiliation:

1. Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary

2. Kálmán Laki Doctoral School of Biomedical and Clinical Sciences , University of Debrecen , Debrecen , Hungary

3. Department of Cardiology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary

4. Department of Surgery, Faculty of Medicine , University of Debrecen , Debrecen , Hungary

5. Department of Emergency Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary

Abstract

Abstract Objectives Serum angiotensin-converting enzyme (ACE) is the only biomarker routinely used in the laboratory diagnostics of sarcoidosis, and ACE inhibitor (ACEi) drugs are among the most prescribed drugs worldwide. Taking ACEi can mislead medical teams by lowering ACE activity, delaying diagnosis and giving a false impression of disease activity of sarcoidosis. We aimed to develop a simple method to detect the presence of ACEi drugs in samples, to investigate the ACEi medication-caused interference and consequences in a retrospective study. Methods ACE activity and the level of ACE inhibition were determined for 1823 patients with suspected sarcoidosis. These values were compared with the therapeutic information at the first and follow-up visits. Results A total of 302 patients had biochemical evidence of an ACEi drug effect during diagnostic ACE activity testing. In their case, ACE activity was significantly lower (median(IQR): 4.41 U/L(2.93–6.72)) than in patients not taking ACEi (11.32 U/L(8.79–13.92), p<0.01). In 62 sarcoidosis patients, the ACEi reduced ACE activity to the reference range or below. Only in 40 % of the cases was the medication list recorded in the outpatient chart and only in 3 cases was low ACE activity associated with ACEi use. 67 % of the repeated ACE activity measurements were also performed during ACEi therapy. Conclusions Our study revealed that the use of ACEi is common in patients with suspected sarcoidosis. The ACE activity lowering effect of ACEi drugs may escape the attention of medical teams which can lead to diagnostic errors and unnecessary tests. Nevertheless, these pitfalls can be avoided by using a method suggested by our team.

Funder

Richter Gedeon Talentum Alapítvány

Innovációs és Technológiai Minisztérium

Magyar Tudományos Akadémia

Publisher

Walter de Gruyter GmbH

Subject

Biochemistry (medical),Clinical Biochemistry,General Medicine

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