A retrospective single-center study included 229 adult patients with sarcoidosis diagnosed between 2000 and 2025 (mean age 51 years, 57.64% female). The mean values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were 2.57, 158.97, and 3.17, respectively. Higher NLR was independently associated with extrathoracic lymph node involvement (OR = 13.42, 95% CI 1.91–94.32, p = 0.001), spleen (OR = 83.05, 95% CI 6.75–1021.09, p = 0.001), and multiorgan disease (OR = 24.60, 95% CI 6.75–1021.09, p = 0.001). CI 5.90–102.00, p < 0.001). Log-transformed NLR confirmed associations with spleen (OR = 2.74 per 10% increase, 95% CI 1.92–3.91) and extrathoracic lymph nodes (OR = 2.17 per 10% increase, 95% CI 1.60–2.94). Higher PLR was associated with extrathoracic lymph node involvement (OR = 1.01, 95% CI 1.00–1.01, p = 0.00). The area under the ROC curve for NLR was 0.51 in ≥ 2 organs, 0.69 in ≥ 3 organs and 0.99 in ≥ 4 organs.