Studying Microalbuminuria In Patients With COPD In Relation To The New Version Of Global Initiative For Chronic Obstructive Lung Disease

Background: Microalbuminuria, used as a marker of endothelial dysfunction, is a predictor of mortality and of cardiovascular events. Microalbuminuria (MAB) in chronic obstructive lung disease (COPD) is attributed to generalized endothelial dysfunction as a result of systemic inflammation, which could be a significant marker for early cardiovascular abnormality. Objectives: Study the relationship between microalbuminuria and disease class in subjects with COPD classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 “A, B, C, D” classification in absence of hypertension and diabetes ,and to Evaluate the clinical features that may predict cardiovascular risk in subjects with COPD. Setting: Chest Department and outpatient clinic, Beni-Suef University Hospital. Methods: Prospective Study included 60 patients who were diagnosed as COPD by Pulmonary function tests. All patients were subjected to clinical examination, Chest x ray, spirometry  and Urinary albumin/creatinine ratio. Results: Urinary albumin/creatinine ratios were significantly higher in subjects who have more symptoms and high future risk (categories C, D) than in those with fewer symptoms and low future risk (categories A, B). A Significant differences were noted when the subjects were grouped based on PaO₂ (<65mmHg versus >65mmHg), PaCO₂ (<41mmHg versus >41mmHg), arterial oxygen saturation (<92% versus >92%), FEV1 (median split <60% versus >60%). There was a statistically significant strong negative correlation between the alb/creat ratio and FEV1% (r=-0.937, p=0.000), PaO₂ (r=-0.929, p=0.000) and SaO₂(r=-0.934,p=0.000). There was a statistically significant strong positive correlation between the alb/creat ratio and Severity of COPD Gold categories (r=0.931, p=0.000), PaCO₂ (r=0.930, p=0.000) and number of hospital admissions last year (r=0.946, p=0.000). There was a highly significant association between high level alb/creat ratio and the presence of pulmonary hypertension (P <0.001). Conclusions: There is a strong correlation between microalbuminuria and the new version of GOLD A, B, C and D classification. Because the diagnosis of microalbuminuria is simple, inexpensive, and noninvasive, it can be evaluated routinely in COPD cases, especially those with many symptoms who are at higher risk, to early predict cardiovascular morbidity and mortality.