Validation of the GOLD 2013 classification in predicting exacerbations and mortality in Taiwanese patients with chronic obstructive pulmonary disease

Chen, Chiung-Zuei; Ou, Chien-Hui; Hsu, Chih Hui; Hsiue, Tzuen Ren

doi:10.1016/j.jfma.2014.12.003

Cited by 7 publications

(4 citation statements)

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“… 14 In addition, several studies have shown that the ABCD classification is not a better predictor of mortality than spirometric grades. 8 , 15 – 17 In the present study, although a statistically significant difference was observed across the ABCD groups and the spirometric grades for the GOLD 2017 classification, it did not perform well with regard to predicting mortality. The GOLD guidelines for COPD diagnosis and management do not address clinical phenotypes and comorbidities.…”

Section: Discussioncontrasting

confidence: 85%

Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients

Han¹,

Hsiue²,

Tsai³

et al. 2018

COPD

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Background and objectiveA multidimensional assessment of COPD was recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2013 and revised in 2017. We examined the ability of the GOLD 2017 and the new 16 subgroup (1A–4D) classifications to predict clinical outcomes, including exacerbation and mortality, and compared them with the GOLD 2013 classifications.MethodsPatients with COPD were recruited from January 2006 to December 2017. The predictive abilities of grades 1–4 and groups A–D were examined through a logistic regression analysis with receiver operating curve estimations and area under the curve (AUC).ResultsA total of 553 subjects with COPD were analyzed. The mortality rate was 48.6% during a median follow-up period of 5.2 years. Both the GOLD 2017 and the 2013 group A–D classifications had good predictive ability for total and severe exacerbations, for which the AUCs were 0.79 vs 0.77 and 0.79 vs 0.78, respectively. The AUCs for the GOLD 2017 groups A–D, grades 1–4, and the GOLD 2013 group A–D classifications were 0.70, 0.66, and 0.70 for all-cause mortality and 0.73, 0.71, and 0.74 for respiratory cause mortality, respectively. Combining the spirometric staging with the grouping for the GOLD 2017 subgroups (1A–4D), the all-cause mortality rate for group B and D patients was significantly increased from subgroups 1B–4B (27.7%, 50.6%, 53.3%, and 69.2%, respectively) and groups 1D–4D (55.0%, 68.8%, 82.1%, and 90.5%, respectively). The AUCs of subgroups (1A–4D) were 0.73 and 0.77 for all-cause and respiratory mortality, respectively; the new classification was determined more accurate than the GOLD 2017 for predicting mortality (P<0.0001).ConclusionThe GOLD 2017 classification performed well by identifying individuals at risk of exacerbation, but its predictive ability for mortality was poor among COPD patients. Combining the spirometric staging with the grouping increased the predictive ability for all-cause and respiratory mortality.Summary at a glanceWe validate the ability of the GOLD 2017 and 16 subgroup (1A–4D) classifications to predict clinical outcome for COPD patients. The GOLD 2017 classification performed well by identifying individuals at risk of exacerbation, but its predictive ability for mortality was poor. The new 16 subgroup (1A–4D) classification combining the spirometric 1–4 staging and the A–D grouping increased the predictive ability for mortality and was better than the GOLD 2017 for predicting all-cause and respiratory mortality among COPD patients.

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Section: Discussioncontrasting

confidence: 85%

Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients

Han¹,

Hsiue²,

Tsai³

et al. 2018

COPD

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“…4 Studies have compared the discrimination abilities of the GOLD 2007 and GOLD 2011 classifications to predict exacerbation and mortality. [4][5][6][7][8] Johannessen et al 5 found that the GOLD 2007 and GOLD 2011 classifications predicted respiratory hospitalization similarly well; however, Lange et al 6 and Chen et al 7 found that the GOLD 2011 classification was better than the GOLD 2007. In a pooled analysis of 22 cohorts, the GOLD 2007 and GOLD 2011 classifications did not differ significantly in predicting mortality.…”

Section: Introductionmentioning

confidence: 99%

<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Bhatta¹,

Leivseth²,

Mai³

et al. 2020

COPD

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These authors contributed equally to this workPurpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods: We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995)(1996)(1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results: Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (p trend =0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion: The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.

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“…They are composed of two dimensions, the COPD assessment test (CAT) and the modified Medical Research Council (mMRC) dyspnoea score for presenting symptom evaluation, lung function (GOLD stage classification) and exacerbation frequency for future risk evaluation. A series of validation studies has been conducted in different region, and showed some similar results, such as a relatively low number of category C patients, significant heterogeneity in prospective exacerbation rates in category D, no differences in the predictive value of mortality for GOLD 2011 and GOLD 2007, and a better predictive value of exacerbation for GOLD 2011 and GOLD 2007 [18]. KOBLIZEK et al [4] also compared Spanish phenotypes with GOLD categories (2011 version) and showed that the majority of frequent exacerbators were in category D regardless of the coexistence of chronic bronchitis, whereas 39% of non-exacerbators and 56% of those with ACOS were also in category D, indicating marked heterogeneity in this category.…”

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confidence: 81%

Phenotypes contribute to treatments

Shi

2017

Eur Respir J

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Validation of the GOLD 2013 classification in predicting exacerbations and mortality in Taiwanese patients with chronic obstructive pulmonary disease

Abstract: The GOLD 2013 classification has powerful ability to predict exacerbation, but poor ability to predict mortality. The prognostic validity of the GOLD 2013 classification to predict exacerbations was better than the GOLD 2007 classification.

Cited by 7 publications

References 10 publications

Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients

Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients

<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Phenotypes contribute to treatments

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Validation of the GOLD 2013 classification in predicting exacerbations and mortality in Taiwanese patients with chronic obstructive pulmonary disease

Abstract: The GOLD 2013 classification has powerful ability to predict exacerbation, but poor ability to predict mortality. The prognostic validity of the GOLD 2013 classification to predict exacerbations was better than the GOLD 2007 classification.

Cited by 7 publications

References 10 publications

Validation of the GOLD 2017 and new 16 subgroups (1A&ndash;4D) classifications in predicting exacerbation and mortality in COPD patients

Validation of the GOLD 2017 and new 16 subgroups (1A&ndash;4D) classifications in predicting exacerbation and mortality in COPD patients

<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Phenotypes contribute to treatments

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Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients

Validation of the GOLD 2017 and new 16 subgroups (1A–4D) classifications in predicting exacerbation and mortality in COPD patients