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

Abstract

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.

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

“…11 Other studies have compared the GOLD 2017 with the previous GOLD classifications to predict COPD exacerbation. In contrast to our study, three studies 11,12,35 observed that the GOLD 2017 and the GOLD 2011 classifications predicted exacerbation similarly well. The discrepancies might be because these studies did not take exacerbations as time-to-event data when comparing the discrimination ability.…”

“…4 Since the publication of the GOLD 2017 classification, the prognostic value of this classification has been debatable with less clear findings. [9][10][11][12] To our knowledge, only one study has compared all three GOLD classifications and found that the GOLD 2017 classification predicted respiratory and all-cause mortality similarly well as the GOLD 2007 and GOLD 2011 classifications. 9 No previous studies have investigated the risk of COPD hospitalization using the GOLD 2017 classification or compared their discrimination ability with the previous GOLD classifications to predict COPD hospitalization.…”

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

“…Our study confirms that patients classified as GOLD A had the best survival, and patients with GOLD D had the higher mortality in both classifications [ 22 – 24 ]. Mortality of groups B and C in GOLD 2015 lay in between A and D groups and often overlapped.…”

Validation of the Summit Lab Score in Predicting Exacerbations of Chronic Obstructive Pulmonary Disease Among Individuals with High Arterial Stiffness

“… 11 However, these may have limitations. For instance, inconsistent mortality risk stratification for GOLD A-B-C-D, 17 weak prediction of AECOPD risk for DOSE, 18 and a need for further validation in longitudinal cohort studies and randomized controlled trials for SCOPEX. 11 Furthermore, risk scoring systems designed for the general population with COPD may not be appropriate in patients with high CV risk, considering that CV risk factors and CVD are associated with comparatively poorer respiratory and CV outcomes.…”