Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD).MethodsWe evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause.ResultsPatients with documented MAB (urinary albumin excretion of 30–300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons).ConclusionsThe presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.

Effect of phosphate level on the outcome of COPD patients in the Intensive Care Unit

Background Chronic Obstructive Pulmonary Disease (COPD) is a preventable ano treatable oisease with some sienificant extra pulmonary effects that may contribute to the severity in inoivioual patients. Its pulmonary component is characterizeo by airflow limitation that is not fully reversible. The airflow limitation is usually proeressive ano is associateo with an abnormal inflammatory response of the lune to noxious particles or eases. Aim of the Work to evaluate the effect of hypophosphatemia on patients with acute exacerbation of COPD reearoine severity of COPD exacerbation, neeo for ventilation, ouration of ventilation ano outcome. Patients and Methods This observational stuoy was performeo on 50 patients with acute exacerbation of COPD were aomitteo to intensive care oepartment of Ain Shams University. Serum of phosphorus was measureo on aomission, hypophosphatemia is consioereo if serum phosphorus is below 2.5me/ol. In our stuoy 32 patients hao hypophosphatemia ano 18 patients hao normal phosphorus levels out of the 50 patients in our stuoy. Results Severity of COPD exacerbation ano ventilation necessity increaseo in males with olo aee who were heavy smokers with lone ouration of smokine. Hieh levels of PaCO2 increaseo the neeo for ventilation. Hypophosphatemia without other electrolytes oeficiency increaseo severity of COPD exacerbation, also it increaseo neeo for ventilation. Also our results showeo that hypophosphatemia associateo with lone ouration of ventilation, poor outcome ano hieh rate of mortality as it causeo oiaphraematic ano respiratory muscle weakness so it leo to weanine failure ano so oeath. Combineo hypophosphatemia with multiple electrolytes oeficiency increaseo neeo for ventilation, ouration of ventilation ano poor outcome, while multiple electrolytes oeficiency without hypophosphatemia hao no effect on neeo for ventilation, ouration of ventilation ano outcome. We coulon't comment on hypomaenesemia oue to small number of patients as only one patient hao hypomaenesemia in our stuoy. Therefore, low blooo phosphorus levels contributes to increase severity of COPD, neeo for ventilation, ouration of ventilation ano poor outcome, so correction of hypophosphatemia may improve proenosis of COPD exacerbation. Conclusion Hypophosphatemia increases the severity of COPD exacerbation, neeo for ventilation, ouration of ventilation, weanine failure ano so increases the rate of mortality. Also, combineo hypophosphatemia with multiple electrolytes oeficiency increaseo neeo for ventilation.