International Journal of COPD (Apr 2023)

Prognostic Properties of the GOLD 2023 Classification System

  • Brat K,
  • Svoboda M,
  • Zatloukal J,
  • Plutinsky M,
  • Volakova E,
  • Popelkova P,
  • Novotna B,
  • Dvorak T,
  • Koblizek V

Journal volume & issue
Vol. Volume 18
pp. 661 – 667

Abstract

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Kristian Brat,1– 3 Michal Svoboda,4 Jaromir Zatloukal,5,6 Marek Plutinsky,1,2 Eva Volakova,5,6 Patrice Popelkova,7,8 Barbora Novotna,9 Tomas Dvorak,10 Vladimir Koblizek11,12 1Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic; 2Faculty of Medicine, Masaryk University, Brno, Czech Republic; 3International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic; 4Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic; 5Pulmonary Department, University Hospital Olomouc, Olomouc, Czech Republic; 6Faculty of Medicine, Palacky University, Olomouc, Czech Republic; 7Pulmonary Department, University Hospital Ostrava, Ostrava, Czech Republic; 8Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 9Pulmonary Department, Bulovka Hospital, Prague, Czech Republic; 10Pulmonary Department, Mlada Boleslav Hospital, Mlada Boleslav, Czech Republic; 11Pulmonary Department, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; 12Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech RepublicCorrespondence: Kristian Brat, Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska street 20, Brno, 62500, Czech Republic, Tel +420 532 232 556, Email [email protected]: Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published an update on the Global Strategy for Prevention, Diagnosis and Management of COPD, introducing a new classification of chronic obstructive pulmonary disease (COPD). Our aim was to assess the prognostic value of the new GOLD classification system in comparison with the previous GOLD classification systems (GOLD stages I–IV and GOLD groups A-D) and the BODE index.Methods: We used the data of 784 patients with COPD from the Czech Multicenter Research Database of COPD. Patient survival was analyzed with the use of Kaplan–Meier estimate and Cox model of proportional risks. ROC analysis and area under curve (AUC) were used for comparison of GOLD classifications and BODE index. The analyses were performed with the use of software R (version 4.2.0).Results: We analyzed data of 782 patients with complete data on GOLD classifications. The study population comprised 72.9% of men, 89.1% current or former smokers, with a mean age of 66.6 years, a mean BMI of 27.4 and a mean FEV1 44.9% of predicted. Probability of 5-year survival differed by GOLD classification. Application of the 2023 GOLD classification showed increased risk of death in group B (HR 1.82, 95% CI 1.14– 2.92; p = 0.013) and in group E (HR 2.48, 95% CI 1.54– 3.99; p˂0.001). The ROC analysis showed that the overall prognostic value of the 2023 GOLD classification was similarly weak to previous A-D GOLD classification schemes (AUCs 0.557– 0.576) and was lower compared to the GOLD 1– 4 system (AUC 0.614) and even lower when compared to the BODE index (AUC 0.715).Conclusion: We concluded that the new GOLD classification system has poor prognostic properties and that specific prediction tools (eg, the BODE index) should be used for mortality risk assessment.Keywords: GOLD classification, COPD, mortality, prognosis

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