Prognostic Accuracy of Three COPD Classification Systems in Relation to Long-Term Mortality of COPD Patients: A Prospective Multicenter Study
Abstrakt
Recent research showed group B patients express higher mortality compared to group C patients when GOLD A-D grouping is used. We aimed to compare the prognostic accuracy of three GOLD classification systems, I-IV (pre-2011), A-D (2011-2016) and A-D (2017-present) in relation to mortality, exacerbation risk, quality of life (QoL) assessment and specific treatments use in a real-life COPD cohort.
We used the data of 720 patients from the Czech Multicenter Research Database of COPD. Four-year mortality and time-to-exacerbation using the GOLD pre-2011, 2011-2016 and 2017-present classification schemes were assessed.
Moreover, distribution of specific treatments use and QoL measures were analyzed. The GOLD I-IV classification system showed gradual increase in 4-year mortality across the stages (GOLD II 18.8%, III 28.5%, IV 38.7%) (p=0.001).
Using the A-D 2011-2016 classification scheme, group C patients had lower mortality (16.7%) than group B (18.7%) (p=0.009). The A-D 2017-present classification showed higher mortality in group B (25.5%) compared to group C (20%) (p=0.05).
For additional outcomes, the GOLD I-IV scheme showed highest match between the calculated 4-year exacerbation risk and QoL measures and GOLD stage/grouping. In terms of specific treatment distributions, various patterns for each GOLD classification system were observed with best match of GOLD 2017-present system to the layout of GOLD groups and categories.
We conclude the GOLD I-IV classification system had the highest accuracy related to mortality, QoL measures and exacerbation risk prediction, while the A-D 2017-present scheme was most accurate within severity of symptoms prediction reflected also by more frequent specific treatments use.