Serum Bilirubin Levels in Patients with COPD during Acute Exacerbation

The Aim of the Work: To study the relationship between levels of serum bilirubin in patients with chronic obstructive pulmonary disease (COPD) during an exacerbation.

Patients and Methods: One hundred fifty (150) patients, including 117 males and 33 females, participated in the study. All patients had been diagnosed with COPD and were experiencing exacerbation; they were admitted to the chest medicine department at Benha University Hospital in Egypt. A full medical history was taken from all patients, and all were given both general and local examinations. The hospital took standard chest x-rays, both posteroanterior (PA) and lateral views. Body mass index (BMI), pulmonary function tests (spirometry) before and after bronchodilation, electrocardiography, a complete blood count, liver function tests, kidney function tests, and fasting blood sugar were also completed. The study excluded patients with any disease that might elevate serum bilirubin, such as hepatic diseases, inflammatory bowel diseases, end-stage renal disease, diabetes mellitus, hypertension, ischemic heart disease, arthritis, cerebral vascular diseases, and any systemic infection or inflammation that could be associated with an increase in the bilirubin level. Also, patients were excluded if they had tuberculosis, bronchiectasis, malignancy, or connective tissue disorders.

Results: The levels of serum total and indirect bilirubin were high in COPD patients with acute exacerbation. Significant negative correlation was observed between serum total and indirect bilirubin levels with the following: the pre-bronchodilator ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC); the pre-bronchodilator FEV1 %, and the forced expiratory flow 25–75 % (FEF25–75%). Non-significant negative correlation was observed between serum total bilirubin levels and the smoking index.

Conclusion: A patient’s bilirubin level may be a helpful indicator of COPD exacerbation, and a COPD patient may receive a beneficial effect from some levels of hyperbilirubinemia.