Published: 2020-01-27

Comparative study of some routinely measured Serum biochemical parameters between acute exacerbation of Chronic Obstructive Pulmonary Disease and stable Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Kolkata: an attempt to make simple prognostic indicators

Subhankar Chakraborty, Swapnendu Misra, Sumanta Jha, Sukanta Kodali, Abhijit Mandal


Background: Patients with COPD often have exacerbations which frequently require hospitalization, resulting in higher mortality rates and costs than patients managed at OPD. Some easily available blood parameters in both stable COPD and AECOPD patients are measured that can be done in every patient even in poor resource settings. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients with or without any prognostic significance.

Methods: In institution based observational case control study, authors measured 1.  FBS and PPBS 2. Serum Urea and Creatinine 3. Serum Electrolytes- Na+, K+, Cl- 4. LFT  5. Uric acid in both stable COPD(n=50) and AECOPD (n=50) patients. Finally, Results were analysed statistically to find out if there is any presence of significant difference of biochemical profile in stable COPD patients and AECOPD patients.

Results: AECOPD patients had statistically significant higher urea, uric acid levels and higher fasting hyperglycemia than stable COPD patients. Hypernatremia, hyponatremia and hyperkalemia, hypokalemia - all were significantly higher in AECOPD group. Low level of serum bilirubin and higher level of AST and ALP were common in AECOPD patients. AECOPD patients with high urea value (>50 mg/dl) (but not high creatinine) was associated with poor patient outcome in respect to ICU transfer, death and prolonged hospital stay. Low bilirubin, high ALP and AST level in AECOPD patients was associated with higher ICU transfer and mortality but only high ALP level was associated with prolonged hospital stay. High uric acid level (>6 mg/dl) was a major determinant of ICU transfer, mortality and prolonged hospital stay.

Conclusions: Predicting exacerbation by these parameters early in the course of disease can decrease morbidity and mortality as well as health care cost to great extent. By measuring the changes in it can also be predicted early who will need ICU support in future and who can be treated at ward.


Chronic obstructive pulmonary disease, Urea, Creatinine, Electrolytes, Liver function tests, Uric acid

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Arora N, Daga MK, Mahajan R, Prakash SK, Gupta N. Chronic Obstructive Airway Disease in a Hospital Based Study. Indian J Chest Dis Allied Sci. 2001;43:157-62.

Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. Jama. 1995 Dec 20;274(23):1852-7.

Louhelainen N, Myllärniemi M, Rahman I, Kinnula VL. Airway biomarkers of the oxidant burden in asthma and chronic obstructive pulmonary disease: current and future perspectives. Inter J Chronic Obstructive Pulmonary Dis. 2008 Dec;3(4):585-603.

Koutsokera A, Kostikas K, Nicod LP, Fitting JW. Pulmonary biomarkers in COPD exacerbations: a systematic review. Respiratory Res. 2013 Dec;14(1):111.

Shoki AH, Mayer-Hamblett N, Wilcox PG, Sin DD, Quon BS. Systematic review of blood biomarkers in cystic fibrosis pulmonary exacerbations. Chest. 2013 Nov 1;144(5):1659-70.

Agusti A, Sin DD. Biomarkers in COPD. Clinics Chest Med. 2014 Mar 1;35(1):131-41.

Kamat Sudhakar R. Chronic Obstructive Pulmonary Disease. Lung Biology in health and disease An Indian pusputre. 1991;51:399-422.

Sethi S, Muscarella K, Evans N, Klingman KL, Grant BJ, Murphy TF. Airway inflammation and etiology of acute exacerbations of chronic bronchitis. Chest. 2000 Dec 1;118(6):1557-65.

Das P, Bandyopadhyay M, Baral K, Paul R, Banerjee AK. Dyselectrolytemia in chronic obstructive pulmonary diseases with acute exacerbation. Nigerian J Physiol Sci. 2010;25(1):25-7.

Farber MO, Bright TP, Strawbridge RA, Robertson GL, Manfredi F. Impaired water handling in chronic obstructive lung disease. J Lab Clini Med. 1975 Jan 1;85(1):41-9.

Farber MO, Kiblawi SS, Strawbridge RA, Robertson GL, Weinberger MH, Manfredi F. Studies on plasma vasopressin and the renin-angiotensin-aldosterone system in chronic obstructive lung disease. J Lab Clini Med. 1977 Aug;90(2):373-80.

Brown KE, Sin DD, Voelker H, Connett JE, Kunisaki KM. Association Between Serum bilirubin And Risk Of COPD Exacerbations. InB42. COPD: BIOMARKERS. American Thoracic Society. 2016 May:A3503-A3503.

Braghiroli A, Sacco C, Erbetta M, Ruga V, Donner CF. Overnight urinary uric acid: creatinine ratio for detection of sleep hypoxemia. Am Rev Respir Dis. 1993 Jul;148(1):173-8.

Lewis JG, Gardner JE. The relation of serum uric acid to haemoglobin level in patients with cardiac and respiratory disease. J Clini Pathol. 1960 Nov 1;13(6):502-5.

Saito H, Nishimura M, Shibuya E, Makita H, Tsujino I, Miyamoto K, et al. Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine. Chest. 2002 Nov 1;122(5):1686-94.

Lopez IH. Serum uric acid levels among patients with chronic obstructive pulmonary disease. Chest 2003;124(4_MeetingAbstracts):168S-a.