Does the 2013 GOLD classification improve the ability to predict lung function decline, exacerbations and mortality: a post-hoc analysis of the 4-year UPLIFT trial

BMC Pulmonary Medicine

Maureen P M H Rutten-van Mölken¹  Karin Becker²  Norbert Metzdorf²  Inge Leimer²  Lucas M A Goossens¹ 

[1] Institute for Medical Technology Assessment, Erasmus University, P.O. Box 1738, 3000 Rotterdam, DR, The Netherlands;Boehringer Ingelheim GmbH, Binger Str. 173, 55216 Ingelheim, Germany

关键词: Mortality;    Lung function decline;    Exacerbations;    GOLD classification 2013;    GOLD classification 2007;    COPD;   

Others  :  1091786
DOI  :  10.1186/1471-2466-14-163

 received in 2014-06-13, accepted in 2014-10-02,  发布年份 2014

【 摘 要 】

Background

The 2013 GOLD classification system for COPD distinguishes four stages: A (low symptoms, low exacerbation risk), B (high symptoms, low risk), C (low symptoms, high risk) and D (high symptoms, high risk). Assessment of risk is based on exacerbation history and airflow obstruction, whatever results in a higher risk grouping. The previous system was solely based on airflow obstruction. Earlier studies compared the predictive performance of new and old classification systems with regards to mortality and exacerbations. The objective of this study was to compare the ability of both classifications to predict the number of future (total and severe) exacerbations and mortality in a different patient population, and to add an outcome measure to the comparison: lung function decline.

Methods

Patient-level data from the UPLIFT trial were used to analyze 4-year survival in a Weibull model, with GOLD stages at baseline as covariates. A generalized linear model was used to compare the numbers of exacerbations (total and severe) per stage. Analyses were repeated with stages C and D divided into substages depending on lung function and exacerbation history. Lung function decline was analysed in a repeated measures model.

Results

Mortality increased from A to D, but there was no difference between B and C. For the previous GOLD stages 2–4, survival curves were clearly separated. Yearly exacerbation rates were: 0.53, 0.72 and 0.80 for stages 2–4; and 0.35, 0.45, 0.58 and 0.74 for A-D. Annual rates of lung function decline were: 47, 38 and 26 ml for stages 2–4 and 44, 48, 38 and 39 for stages A-D. With regards to model fit, the new system performed worse at predicting mortality and lung function decline, and better at predicting exacerbations. Distinguishing between the sub-stages of high-risk led to substantial improvements.

Conclusions

The new classification system is a modest step towards a phenotype approach. It is probably an improvement for the prediction of exacerbations, but a deterioration for predicting mortality and lung function decline.

Trial registration

ClinicalTrials.gov NCT00144339 (September 2, 2005).

【 授权许可】

   
2014 Goossens et al.; licensee BioMed Central Ltd.

【 图 表 】

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