Evaluation of serum ischemia modified albumin level in determining the prognosis of chronic obstructive lung disease exacerbation

Introduction: Chronic obstructive pulmonary disease (COPD) is an important public health problem due to the high risk of morbidity and mortality. The main factors involved in the pathogenesis and progression of the disease are inflammation and oxidative stress. It is known that reactive oxygen radicals increase and the balance between oxidant and antioxidant systems is disturbed during COPD exacerbation. Ischemia-modified albumin (IMA) is a modified serum albumin that occurs under oxidative stress conditions. IMA is shown to be elevated in myocardial ischemia, pulmonary embolism, cardiopulmonary resuscitation, infections, cerebrovascular ischemia, acute mesenteric ischemia, diabetes mellitus, end stage kidney diseases, some cancers, sepsis, metabolic syndrome, liver diseases, systemic sclerosis and obstructive sleep apnea syndrome. There is only one study with a small number of patients evaluating the IMA level in exacerbation of COPD. In our study, we aimed to investigate the usability of IMA level in determining the prognosis of COPD. Material-Method: A total of 150 cases, 90 from the COPD group and 60 from the control group were included in the study. Patients were evaluated in three subgroups: stable COPD outpatients (n=34), non-invasive mechanical ventilation (NIMV) applied (n=33) and NIMV non-applied COPD exacerbation patients (n=23). In addition, patients were analyzed in 3 subgroups, regardless of NIMV treatment, as outpatient stable COPD patients, hospitalized COPD exacerbation patients, and intensive care hospitalized COPD exacerbation patients. Patients underwent IMA, complete blood count, C-reactive protein (CRP), biochemical analysis and SpO2 evaluations. Sociodemographic characteristics, medical histories and length of hospital stay were recorded. Results: The mean age of patients with COPD was 67 (min-max: 51-80), and the mean age of the control group was 65 (min-max: 50-80). In our study, IMA values of stable COPD patients, NIMV applied COPD exacerbation patients and NIMV nonapplied COPD exacerbation patients were compared. There was no difference between the stable COPD patients and the control group's IMA levels (p = 0.258). The mean of the IMA levels of the groups with and without NIMV were higher than the stable COPD group (p <0.001). The mean of the IMA levels of the group with NIMV was also higher than the group without NIMV (p<0.001). A negative correlation was found between IMA and albumin values (p<0.001, r = 0.476). Negative correlation was also found between IMA and SpO2 values (p<0.001; r = 0.615). whereas a positive correlation found between IMA and CRP (r = 0.539; p<0.001). Conclusion: It is thought that IMA may be useful in evaluating the need for noninvasive mechanical ventilation during the exacerbation of COPD, and even in determining the need for the intensive care unit during the exacerbation