Serum bilirubin and the risk of chronic obstructive pulmonary disease exacerbations

Brown, Kirstin E.; Sin, Don D.; Voelker, Helen; Connett, John E.; Niewoehner, Dennis E.; Kunisaki, Ken M.

doi:10.1186/s12931-017-0664-0

Cited by 16 publications

(30 citation statements)

References 20 publications

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“…It suggests that bilirubin may has a protective effect on lung tissue by impressing the in ammation and oxidative stress response in lungs [31], and was associated with a lower risk of respiratory disease and all-cause mortality [32]. Kirstin E Brown et al [13]also showed, as in our study, that elevated serum bilirubin level are associated with a lower risk of AECOPD, hence it can be used as a biomarker of AECOPD risk.…”

Section: Discussionsupporting

confidence: 68%

“…Recently, researchers have found that neutrophil-to-lymphocyte ratio(NLR) can not only predict COPD progression and outcomes, but also an independent predictor of COPD mortality [9][10][11][12]. Bilirubin is also con rmed to be a protective index that associated with a lower rate of COPD progression and risk of exacerbation [13]. But up till now, few studies have explored the predictive value of NLR and bilirubin levels in the readmission of AECOPD.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Dai

Liang²,

2020

Preprint

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Objective To analyze acute exacerbation of chronic obstructive pulmonary disease(AECOPD) readmission events and to determine whether neutrophil-to-lymphocyte ratio(NLR) and bilirubin level are associated with readmission after discharge due to AECOPD .Methods A total of 170 patients with AECOPD were included. Patients were stratified into the readmission group if patients have two or more readmission within 2 years of the previous discharge and non-readmission group with one readmission or none within 2 years of the last discharge. Basic characteristics, laboratory examinations and clinical data of them were collected retrospectively and compared between these two groups. Then the patients were separated by the cutoffs of NLR and bilirubin level. The number of all-cause readmission within 2 years, time to first COPD-related readmission, 1-year and 2-year COPD-related readmission, 1-year and 2-year all-cause mortality were compared between groups respectively .Results Compared with readmission group, patients of non-readmission group had shorter length of hospital stay(P=0.034), more systemic corticosteroids use(P=0.007), higher NLR(P=0.001), higher bilirubin levels(P=0.010) and lower eosinophils counts(P=0.001). NLR and bilirubin level at admission can significantly influence the number of all-cause readmission(p=0.002, P<0.001, respectively). Lower bilirubin was associated with an increased risk of 1-year COPD-related readmission(OR 5.063, 95%CI 1.091-23.498) and 2-year COPD-related readmission(OR 4.699, 95% CI 1.269-17.396) .Conclusion For patients with AECOPD, longer hospital stay and less use of systemic corticosteroids may be associated with higher risk of readmission. NLR and bilirubin level at admission may be related to the number of all-cause readmission. Bilirubin can be regarded as a biomarker to predict readmission rates within 2 years after discharged throughout the course of disease.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Dai

Liang²,

2020

Preprint

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“…The beneficial effects of serum bilirubin on respiratory outcomes have been reported in several studies [ 5 , 6 , 12 ]. In a previous study by Temme et al, high serum bilirubin was associated with lower cancer mortality, including that of lung cancer [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Association of serum bilirubin level with lung function decline: a Korean community-based cohort study

Leem

Kim

et al. 2018

Respir Res

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BackgroundBilirubin has been reported to be associated with respiratory diseases due to its antioxidant action. We aimed to evaluate the relationship between serum bilirubin concentration and annual lung function decline in the Korean general population.MethodsThe study included 7986 subjects aged 40–69 years from the Ansung-Ansan cohort database I (2001–2002)–III (2005–2006). We analyzed the relationships between serum bilirubin level and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and mean forced expiratory flow between 25 and 75% of FVC (FEF25–75%) at baseline, as well as the annual average changes in these lung parameters.ResultsThe FEV1, FVC, and FEF25–75% were significantly associated with serum bilirubin levels after adjustment for age, sex, body mass index (BMI), and smoking status (all P < 0.001). When stratified according to smoking status, these relationships were significant in never-smokers. Additionally, serum bilirubin level was negatively associated with the annual decline in FEV1 and FVC, and positively associated with the annual decline in FEV1/FVC after adjustment for age, sex, BMI, baseline lung function, and smoking status (all P < 0.001).ConclusionsWe found significant associations of serum bilirubin levels with FEV1, FVC, and FEF25–75% in the general population, especially in never-smokers. Moreover, serum bilirubin levels were related with the annual decline in FEV1, FVC, and FEV1/FVC ratio.

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“… 17 In addition to its function as an oxidant scavenger, bilirubin protects lipids against oxidant stress and reduces intracellular reactive oxygen species (ROS) production by inhibiting membrane-bound nicotinamide adenine dinucleotide phosphate oxidase. 18 Numerous studies have confirmed the protective effects of bilirubin against oxidant stress-associated pulmonary diseases such as COPD. Moreover, serum bilirubin concentration has been implicated as the biomarker of severity and progression of COPD and an independent prognostic factor in non-small-cell lung cancer (NSCLC) following successful resection.…”

Section: Discussionmentioning

confidence: 98%

“…Based on previous studies, it has been proposed that baseline percent predicted of DLCO-SB is superior to baseline percent predicted FVC as a prognostic indicator in IPF. 23 Pulmonary function progression according to serum bilirubin levels in the healthy general population 13 and patients with COPD 18 have been investigated in human studies, but not in patients with IPF. In our study, serum TBIL and IBIL levels were found to correlate positively with percent predicted of DLCO-SB in IPF patients, while no association was observed between TBIL and pulmonary function, percent predicted of FVC, or percent predicted of FEV1.…”

Section: Discussionmentioning

confidence: 99%

Correlation between serum bilirubin levels and the severity as well as the prognosis of idiopathic pulmonary fibrosis

et al. 2020

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Bilirubin exerts antioxidant activity that has been associated with respiratory diseases. However, the relationship between serum bilirubin levels and idiopathic pulmonary fibrosis (IPF) is not clear. Therefore, in this study, we evaluated the relationship between serum bilirubin levels and the severity as well as the prognosis of IPF. One hundred and forty-six patients with IPF and 69 healthy individuals as the control group were enrolled as a derivation cohort. Routine blood examination and pulmonary function tests were performed and serum bilirubin levels were measured. To validate the value of serum bilirubin levels to predict the survival of patients with IPF, 40 additional IPF patients were included as a validation cohort. IPF patients were followed-up. Patients with IPF had significantly lower levels of serum total bilirubin (TBIL) and direct bilirubin (DBIL) than those in the control group ( P < 0.05). Patients with acute exacerbation of IPF (AE-IPF) had significantly lower levels of serum TBIL and IBIL than those in patients with stable IPF ( P < 0.05). The area under the receiver operating characteristic curve (AUROC) of serum TBIL levels for the prediction of the incidence of AE-IPF was 0.72 (95% CI: 0.56–0.87, P = 0.0057). The best cutoff value of serum TBIL level to predict the survival of patients with IPF was 8.8 μmol/l (AUC = 0.75, 95% CI: 0.64–0.87, P = 0.022). The log-rank test showed a significant difference in survival between the two groups (TBIL ≤8.8 μmol/l and TBIL >8.8 μmol/l) in derivation and validation cohort. Cox multiple regression analysis indicated that serum TBIL levels were an independent prognostic factor for IPF prognosis (HR = 0.582, P = 0.026). Serum TBIL levels might be useful for reflecting the severity and predicting the survival of patients with IPF.

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Serum bilirubin and the risk of chronic obstructive pulmonary disease exacerbations

Cited by 16 publications

References 20 publications

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Association of serum bilirubin level with lung function decline: a Korean community-based cohort study

Correlation between serum bilirubin levels and the severity as well as the prognosis of idiopathic pulmonary fibrosis

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