Distribution and prognostic validity of the new Global Initiative for Chronic Obstructive Lung Disease grading classification.

BACKGROUND The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11 well-defined COPD cohorts and their prognostic validity up to 10 years to predict time to death. METHODS Spirometry in all 11 cohorts was postbronchodilator. Survival analysis and C statistics were used to compare the two GOLD systems by varying time points. RESULTS Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms), 515 (16.3%) were B (low risk, more symptoms), 561 (17.7%) were C (high risk, less symptoms), and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts ( x (2) , P < .01). No differences were seen in the C statistics of old vs new GOLD grading to predict mortality at 1 year (0.635 vs 0.639, P = .53), at 3 years (0.637 vs 0.645, P = .21), or at 10 years (0.639 vs 0.642, P = .76). CONCLUSIONS The new GOLD grading produces an uneven split of the COPD population, one third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.

[1]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.

[2]  J. Soriano,et al.  Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study. , 2012, Chest.

[3]  P. Martínez-Camblor,et al.  A general bootstrap algorithm for hypothesis testing , 2012 .

[4]  A. Serrano-Mollar.  La célula epitelial como factor etiopatogénico de la fibrosis pulmonar , 2012 .

[5]  Nikolaus C. Netzer.  Necesitamos polisomnografías repetidas para cambiar la presión en los pacientes con CPAP , 2012 .

[6]  D. Mannino,et al.  Interpreting lung function data using 80% predicted and fixed thresholds identifies patients at increased risk of mortality. , 2012, Chest.

[7]  Olaf Holz,et al.  Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. , 2011, Chest.

[8]  D. Mannino,et al.  Lung function impairment, COPD hospitalisations and subsequent mortality , 2011, Thorax.

[9]  Gorka Bastarrika,et al.  Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD. , 2011, Chest.

[10]  J. L. López-Campos.  Estrategias de tratamiento en la enfermedad pulmonar obstructiva crónica: una propuesta de sistematización , 2010 .

[11]  J. Wedzicha,et al.  Susceptibility to exacerbation in chronic obstructive pulmonary disease. , 2010, The New England journal of medicine.

[12]  J. Soriano,et al.  Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. , 2010, American journal of respiratory and critical care medicine.

[13]  J. Lima,et al.  The effect of airflow limitation on the cause of death in patients with COPD , 2010, Chronic respiratory disease.

[14]  J. Soriano,et al.  Recent improvement in long-term survival after a COPD hospitalisation , 2010, Thorax.

[15]  J. López-Campos.  Treatment Strategies in Chronic Obstructive Pulmonary Disease: A Proposal for Standardisation , 2010 .

[16]  M. Decramer,et al.  Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial , 2009, The Lancet.

[17]  M. Rodríguez-Carballeira,et al.  Mortalidad posthospitalaria en pacientes reingresadores por EPOC. Utilidad del índice BODE , 2009 .

[18]  P. Jones,et al.  Development and first validation of the COPD Assessment Test , 2009, European Respiratory Journal.

[19]  C. Jenkins,et al.  Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study , 2009, Respiratory research.

[20]  M. Martínez-García,et al.  Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. , 2009, Respiratory medicine.

[21]  C. Esteban,et al.  Predictors of Mortality in Patients with Stable COPD , 2008, Journal of General Internal Medicine.

[22]  E. Benjamin,et al.  Systemic inflammation and COPD: the Framingham Heart Study. , 2008, Chest.

[23]  M. Martínez-García,et al.  with chronic obstructive pulmonary disease Severe acute exacerbations and mortality in patients , 2006 .

[24]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[25]  M. Martínez-García,et al.  Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease , 2005, Thorax.

[26]  B. Celli,et al.  Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. , 2005, American journal of respiratory and critical care medicine.

[27]  H. Kerstjens.  The GOLD classification has not advanced understanding of COPD. , 2004, American journal of respiratory and critical care medicine.

[28]  M. Pencina,et al.  Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation , 2004, Statistics in medicine.

[29]  S. Rennard,et al.  Rescue! Therapy and the paradox of the Barcalounger , 2003, European Respiratory Journal.

[30]  S. Quintana,et al.  Mortality after hospitalization for COPD. , 2002, Chest.

[31]  P. Jones,et al.  Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease , 1999, Thorax.

[32]  M Blettner,et al.  Traditional reviews, meta-analyses and pooled analyses in epidemiology. , 1999, International journal of epidemiology.

[33]  J. Gold,et al.  Validation of a combined comorbidity index. , 1994, Journal of clinical epidemiology.

[34]  D. Cox,et al.  Analysis of Survival Data. , 1985 .