Study the association of chronic obstructive pulmonary disease with early endothelial dysfunction and its impact on cardiovascular system by estimating urinary albumin creatinine ratio

Abstract

Background:Chronic obstructive pulmonary disease (COPD) attribute to systemic inflammation which is responsible for microalbuminuria reflecting endothelial dysfunction, could be a significant surrogate marker of potential cardiovascular morbidity.Objective:The aim of our study was to find out the possible association of COPD with early cardiovascular changes in the form of renal endothelial dysfunction.Settings and Design:Case–control, multi-group, cross-sectional hospital-based study was designed and conducted in the Department of Respiratory Medicine of BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana.Subjects and Methods:The study included 150 subjects, comprising of three groups with each having 50 subjects: Group 1 – acute exacerbation of COPD, Group 2 – stable COPD patients, Group 3 – asymptomatic smokers. Pulmonary function test, urine albumin creatinine ratio (UACR) and brachio-ankle pulse wave velocity were measured in all the subjects.Statistical Analysis:Data were analyzed using SPSS ver 20 (IBM, USA) software. Continuous variables were compared by unpaired Student's t-test while correlation was measured by Pearson correlation test, P < 0.05 was considered statistically significant.Results:The mean urine albumin creatinine ratio UACR value in acute exacerbation of COPD (283.30 mg/g; standard deviation [SD] ±871.98) was found significantly higher compare to control subjects (24.17 mg/g; SD ± 32.105;) P = 0.038. Besides this COPD patients with Type 2 respiratory failure having robust positive correlation in between UACR and arterial blood pH (r = 0.559; P = 0.030) while it was inverse and moderate with partial pressure of arterial oxygen (r = −0.470; P = 0.077).Conclusions:Acute state of COPD with or without Type 2 respiratory failure is having a significant impact on cardiovascular system in the form of early microvascular changes.

Prevalence and clinical significance of microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease

“…13 In the study of Mehmood and Sofi et al, and Agrawal et al, COPD patients having microalbuminuria were more hypoxic than those of COPD patients without microalbuminuria and it was inversely related to PaO2. 10,12 In this study, microalbuminuria was significantly more in COPD patients having PaCO2 ≥45 mmHg as compared to COPD patients having PaCO2 <45 10,12,13 In this study, 6MWD test was also observed and found that; as exercise capacity decreases, the prevalence of Microalbuminuria increases. Kumar et al, also obtained an inverse relationship of 6MWD with Microalbuminuria levels in their study.…”

“…A recent study by Agrawal et al, in 2017 observe prevalence of Microalbuminuria in COPD patients to be 46%. 10 In study of Bulcon et al, in 2013 found that prevalence of Microalbuminuria to be 39%. 11 Mehmood and Sofi et al, in 2015, were also found that MAB was more frequent in COPD patients compared to smokers without obstruction (20.6% vs. 7.4%, respectively).…”

Effects of cigarette smoke on pulmonary endothelial cells

“…Treatment with enalapril blunted these effects in mice, suggesting a role of angiotensin I-converting enzyme (ACE) inhibitors for renal protection in patients with COPD (108). Agrawal et al also demonstrated increased albuminuria in patients with acute exacerbations of COPD (3).…”