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Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations
  1. Konstantinos Bartziokas1,
  2. Christos Kyriakopoulos1,
  3. Evangelia Dounousi2,
  4. Konstantinos Kostikas1
  1. 1Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
  2. 2Nephrology Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
  1. Correspondence to Professor Konstantinos Kostikas, Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece; ktkostikas{at}gmail.com

Abstract

Objectives Microalbuminuria (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).

Methods We 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.

Results Patients 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).

Conclusions The 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.

  • respiratory medicine
  • chronic airways disease

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Contributors KB had full access to all data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. KB, CK, ED and KK contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. All authors were involved with interpretation of the data. All authors critically edited the manuscript for important intellectual content. All authors approved the final version before submission. KB is the guarantor of the present study accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This research is co-financed by Greece and the European Union (European Social Fund-ESF) through the Operational Programme ‘Human Resources Development, Education and Lifelong Learning 2014–2020’ (MIS 5047644).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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