Validity of the GOLD 2017 classification in the prediction of mortality and respiratory hospitalization in patients with chronic obstructive pulmonary disease
Received 24 October 2018
Accepted for publication 29 March 2019
Published 29 April 2019 Volume 2019:14 Pages 911—919
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Seung Jun Lee,1 Sang Suk Yun,1 Sunmi Ju,1 Jung Wan You,1 Yu Ji Cho,1 Yi Yeong Jeong,1 Ju-Young Kim,2 Ho Cheol Kim,2 Jong Deog Lee1
1Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea; 2Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) released an updated document in 2017 that excluded the spirometric parameter in the classification of patients. The validity of this new classification system in predicting mortality and respiratory hospitalization is still uncertain.
Methods: Outpatients (n=149) with chronic obstructive pulmonary disease (COPD) who underwent spirometry and six-minutes walking test from October 2011 to September 2013 were enrolled. The overall mortality and rate of respiratory hospitalization over a median of 61 months were analyzed. Kaplan-Meier survival analyses, receiver operaing curve analyses with areas under the curve (AUCs), and logistic regression analyses for GOLD 2007, GOLD 2011, GOLD 2017, and/or BODE index were performed to evaluate their abilities to predict mortality and respiratory hospitalization.
Results: Forty-two (53.2%) patients in 2011 GOLD C or D group were categorized into 2017 GOLD A or B group. The odds ratios of GOLD 2017 group C and group D relative to group A were 7.55 (95% CI, 1.25–45.8) and 25.0 (95% CI, 6.01–102.9) for respiratory hospitalization. Patients in GOLD 2017 group A and group B had significantly better survival (log-rank test, p<0.001) compared with patients in group D; however, survival among patients in GOLD 2007 groups and GOLD 2011 groups was comparable. The AUC values for GOLD 2007, GOLD 2011, GOLD 2017, and BODE index were 0.573, 0.624, 0.691, 0.692 for mortality (p=0.013) and 0.697, 0.707, 0.741, and 0.754 for respiratory hospitalization (p=0.296), respectively.
Conclusion: The new GOLD classification may perform better than the previous classifications in terms of predicting mortality and respiratory hospitalization.
Keywords: COPD, GOLD classification, mortality, respiratory hospitalization
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