Vascular and psychiatric disorders, infections, HDL, albumin/globulin ratio, direct bilirubin/total bilirubin ratio, PT, plasma thrombin time, fructosamine, plasma carbon dioxide concentration, bicarbonate concentration, standard bicarbonate concentration, extracellular fluid volume depletion, pCO2, and base excess were associated with an increased risk of very severe COPD. This evidence concerns the gene ALB and psychiatric disorder.