The Correlation Between Indirect Bilirubin And Acute Exacerbation Of COPD

Object:By comparing the expression levels of indirect bilirubin between COPD with AECOPD and the differences among different lung function grades in AECOPD,in order to discover the significance of various groups and provide an certain valuable reference for predicting the risk of acute exacerbation in patients with COPD.Methods: A total of 264 patients were enrolled in this study who were admitted to the respiratory department of Yan 'an university hospital and diagnosed with chronic obstructive pulmonary disease from September 2018 to December 2019.Divided into two groups by clinical type : There are 69 patients with stable stage(COPD group)and 195 patients in acute exacerbation(AECOPD group).Further more,according to the results of lung function examination,AECOPD group was divided into Gold 2(60 cases),GOLD 3(60 cases),GOLD 4(63 cases).Diagnostic criteria refer to the ninth edition of internal medicine textbook of people's medical publishing house.During the same period,30 patients were selected from other departments,such as orthopedics department,ophthalmology department and so on,who without liver and gallbladder disease.After admission,all of the patients were asked carefully about their basic information such as age,hypertension,smoking history,diabetes history and so on.AS time as they admitted to hospital,venous blood from elbow was collected to gain the laboratory indicators,such as : blood routine examination,liver function test,kidneyr function test,and record neutrophils%,eosinophils,hemoglobin,indirect bilirubin and uric acid carefully.All patients were examined for lung function according to their condition after admission.Then,compare and analysis: 1?the difference of general and clinical data between COPD group,AECOPD group and control group;2?The difference of general clinical data between Gold 2 group,Gold 3 group,Gold 4 group;3?The difference of IBIL between Gold 2 group,Gold 3 group,Gold 4 group;4?The correlation between IBIL and N%,eosinophils and Gold classification;5?Multivariate logistic regression analysis of independent risk factor for chronic obstructive pulmonary disease;The predictive value of IBIL and eosinophils alone and jointly for AECOPD was evaluated by drawing receiver operating curves.Results:1?Smoking history in COPD group and AECOPD group were higher than that in the control group(p < 0.05);There was no significant difference in sex,history of diabetes among the three groups(p > 0.05).2?There was no significant difference in age,HB,UA among the three group(p > 0.05);EOS,hs-CRP,N% in COPD and AECOPD group were higher than those in control group(p < 0.05),however,IBIL in control group was higher than those in COPD and AECOPD group(p < 0.05).When the three are compared in pairs,there were significant difference in EOS,hs-CRP,N% and IBIL.3?There were no significant differences in age,hs-CRP(hypersensitive c-reactive protein),EOS(eosinophils),HB(hemoglobin),UA(uric acid)between the three groups in the AECOPD group(p > 0.05).The differences in N% and IBIL were statistically significant(p < 0.05),Among them,the level of GOLD grade 2 IBIL was higher than that of GOLD grade 3 and GOLD grade 4 respectively.There was no significant difference between GOLD level 2 and GOLD level 3 in N%,while the expression of GOLD level 4 was significantly higher than that of GOLD level 2 and GOLD 3.4?Pearson and Spearman correlation analysis were used to evaluate the correlation of bio-markers related to IBIL and acute exacerbation of COPD: N%,EOS and GOLD grades were negatively correlated with IBIL levels(r values were-0.19,-0.651 and-0.589,respectively,and all p < 0.05).And the differences were statistically significant.The correlation between IBIL level and hs-CRP was not statistically significant(p > 0.05).5?Logistic regression of risk factors for acute exacerbation of COPD showed that smoking history,hs-CRP,N%,EOS and IBIL were all independent risk factors for acute exacerbation of COPD.6?ROC curve was drawn to evaluate the predictive value of IBIL,blood EOS alone and the combination of the two for AECOPD.When IBIL alone was used to predict AECOPD,the area under the curve(AUC)was 0.826(p < 0.001).When the cut value of IBIL was 7.15 mmol/L,the diagnostic value was the highest,the sensitivity was 68.2,and the specificity was 89.3.When blood EOS alone was used to predict AECOPD,the area under the curve(AUC)was 0.828(p < 0.001).When the cut value of EOS was 0.305×10~9e/L,the diagnostic value was the highest,the sensitivity was 72.9,and the specificity was 82.9.When IBIL and blood EOS were combined for prediction,the AUC increased to 83.7(p < 0.001).Conclusions:1?The level of IBIL in COPD patients was lower than that in the healthy control group,and IBIL gradually decreased with the increase of acute exacerbation and pulmonary function grade severity.2?IBIL was negatively correlated with EOS,reflecting the severity and risk of acute exacerbation of COPD.IBIL was an independent risk factor for acute exacerbation of COPD.3?When IBIL < 7.15mmol/L and EOS > 0.305×10~9e/L,the accuracy of clinical prediction of acute exacerbation of COPD is higher,and the clinical acquisition of IBIL is simple and easy to get,which is conducive to clinicians' early detection of high-risk patients with acute exacerbation of COPD,in order to realize early intervention and customize the treatment plan of self-employed.