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Observational Study
. 2019 Apr 29:14:911-919.
doi: 10.2147/COPD.S191362. eCollection 2019.

Validity of the GOLD 2017 classification in the prediction of mortality and respiratory hospitalization in patients with chronic obstructive pulmonary disease

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 Lee  1
Affiliations
Observational Study

Validity of the GOLD 2017 classification in the prediction of mortality and respiratory hospitalization in patients with chronic obstructive pulmonary disease

Seung Jun Lee et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

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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Conflict of interest statement

All authors certify that there is no conflicts of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
Distribution (%) of patients with COPD by GOLD 2017 and GOLD 2011 classifications.
Figure 2
Figure 2
Comparison of mortality and respiratory hospitalization between the unchanged group C/D and group A/B that was from 2011 GOLD group C/D.
Figure 3
Figure 3
Receiver operator characteristics curves of 2007 GOLD, 2011 GOLD, 2017 GOLD, and BODE index to predict respiratory hospitalization (3-A) and mortality (3-B).
Figure 4
Figure 4
Kaplan-Meier curves of the overall survival according to the 2007, 2011, and 2017 GOLD classifications.
See this image and copyright information in PMC

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