Distribution and Prognostic Validity of the New Global Initiative for Chronic Obstructive Lung Disease Grading Classification
Por:
Soriano JB, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de Torres JP, Martinez-Camblor P, Miravitlles M, Celli BR and Marin JM
Publicada:
1 mar 2013
Resumen:
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 (chi(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. CHEST 2013; 143(3):694-702
Filiaciones:
Soriano JB:
Fundación Caubet-Cimera Centro Internacional de Medicina Respiratoria Avanzada, Bunyola, Spain
Alfageme I:
Área Hospitalaria de Valme, Sevilla, Spain
Almagro P:
Internal Medicine, Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
Casanova C:
Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
Esteban C:
Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
:
Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, Spain
de Torres JP:
Clinica Universidad de Navarra, Pamplona, Spain
Martinez-Camblor P:
Oficina de Investigación Biosanitaria de Asturies and Oviedo University, Oviedo, Spain
Miravitlles M:
Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Celli BR:
Pulmonary and Critical Care Medicine, Harvard University, Brigham and Women's Hospital, Boston, MA
Marin JM:
Hospital Universitario Miguel Servet, Zaragoza, Spain
Oficina Invest Biosanitaria Asturies, Oviedo, Spain.
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