Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data

Abstract

In 2019, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) modified the grading system for patients with COPD, creating 16 subgroups (1A–4D). As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aim to compare the mortality prediction of the 2015 and 2019 COPD GOLD staging systems.We studied 17 139 COPD patients from the 3CIA study, selecting those with complete data. Patients were classified by the 2015 and 2019 GOLD ABCD systems, and we compared the predictive ability for 5-year mortality of both classifications.In total, 17 139 patients with COPD were enrolled in 22 cohorts from 11 countries between 2003 and 2017; 8823 of them had complete data and were analysed. Mean±sd age was 63.9±9.8 years and 62.9% were male. GOLD 2019 classified the patients in milder degrees of COPD. For both classifications, group D had higher mortality. 5-year mortality did not differ between groups B and C in GOLD 2015; in GOLD 2019, mortality was greater for group B than C. Patients classified as group A and B had better sensitivity and positive predictive value with the GOLD 2019 classification than GOLD 2015. GOLD 2015 had better sensitivity for group C and D than GOLD 2019. The area under the curve values for 5-year mortality were only 0.67 (95% CI 0.66–0.68) for GOLD 2015 and 0.65 (95% CI 0.63–0.66) for GOLD 2019.The new GOLD 2019 classification does not predict mortality better than the previous GOLD 2015 system.

Burden of Disease in Patients with Mild or Mild-to-Moderate Chronic Obstructive Pulmonary Disease (Global Initiative for Chronic Obstructive Lung Disease Group A or B): A Systematic Literature Review

“…Higher mortality rates were consistently reported among patients classified as GOLD B compared with patients classified as GOLD A and GOLD C at various timepoints. 15 , 32 , 37 , 40 , 48 , 54–57 A study with a follow-up of 4 years showed significantly higher mortality rates among patients in GOLD group B compared with those in GOLD group A (pre-2017 classification: 18.7% vs 14.3%, p=0.009; 2017 classification: 25.5% vs 14.8%, p=0.050). 52 The use of spirometry findings in addition to the GOLD 2017 “ABCD” classification (to generate eight A/B subgroups) allowed more accurate prediction of mortality in the GOLD A and B groups.…”

Triple Therapy in COPD: Can We Welcome the Reduction in Cardiovascular Risk and Mortality?

“…The decrease of morbidity and mortality in COPD is one of the main objectives of GOLD initiative, which represents the most important guide for the management and staging of COPD ( 29 ). Last updates, matched spirometry staging, symptoms and exacerbations in the ABCD Classifications in order to choose the best treatment approach ( 30 ).…”

“…Indeed, from 2015 to 2019, mortality was taken into account was reconsidered because of similar variability between ABCD groups ( 30 ).…”

High-Density Lipoproteins: A Role in Inflammation in COPD

“…It leads to a large number of cases of seeking medical care and temporary and permanent disability every year in the world [ 3 , 4 ]. Moreover, COPD occupies one of the leading positions in the structure of mortality causes, which undoubtedly emphasizes the urgency of the problem [ 5 , 6 ].…”