Clinical outcome indicators in patients with sarcoidosis: a systematic review

Sarcoidosis is a heterogeneous multisystem granulomatous disease with highly variable clinical manifestations, disease trajectories, and outcomes. The lack of standardized clinical outcome indicators has limited prognostic assessment and the comparability of clinical studies. This systematic review aimed to identify and evaluate quantitative prognostic indicators in adults with sarcoidosis and to assess their associations with disease progression, mortality, and other adverse clinical outcomes. A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed/MEDLINE was searched for original studies published between 2020 and 2025. Fourteen studies, with a summed reported sample size of approximately 6,500 participants, met the inclusion criteria. Outcome indicators were categorized into pulmonary function, imaging, functional capacity, echocardiography, cardiovascular magnetic resonance, and circulating biomarkers. Reduced DLCO, mixed ventilatory defects, elevated Composite Physiological Index values, and specific fibrotic HRCT patterns were associated with increased mortality in pulmonary sarcoidosis. In cardiac sarcoidosis, CMR-derived parameters, including late gadolinium enhancement burden and distribution, ventricular function, and risk-based phenotyping, consistently predicted ventricular arrhythmias, heart failure events, and mortality. Biomarkers such as B-type natriuretic peptide and high-sensitivity cardiac troponin T provided additional prognostic information, while PET-derived inflammatory activity independently predicted adverse outcomes. Overall, several indicators demonstrated significant prognostic value; however, evidence remains fragmented across domains. Future research should focus on developing integrated multidomain outcome models to improve risk stratification and clinical decision-making in sarcoidosis.