Brusse-Keizer M, Klatte M, Zuur-Telgen M, Koehorst-Ter Huurne K, van der Palen J, VanderValk P
a Medical School Twente, Medisch Spectrum Twente , Enschede , The Netherlands.
b Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , The Netherlands.
COPD. 2017 Feb;14(1):7-14. doi: 10.1080/15412555.2016.1206875. Epub 2016 Jul 21.
To better classify patients with chronic obstructive pulmonary disease (COPD) for prognostic purposes and to tailor treatment, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007 classification was revised in 2011. The primary aim of the current data analyses was to evaluate the accuracy of the GOLD 2007 and 2011 GOLD classifications to predict all-cause mortality and morbidity in a well-described COPD cohort. The prognostic values of both GOLD classifications, expressed as the C-statistic, were assessed in the Cohort of Mortality and Inflammation in COPD (COMIC) study of 795 COPD patients, with a follow-up of 3 years. Outcomes were all-cause mortality and morbidity. Morbidity was defined as time until first COPD-related hospitalisation and time until first community-acquired pneumonia (CAP). The prognostic value of the GOLD 2011 classification was compared between symptom classification based on the modified Medical Research Council (mMRC) score and the Clinical COPD Questionnaire (CCQ) scores with two different thresholds. Although the GOLD 2011 CCQ classification had the highest accuracy to predict mortality and morbidity in our study, the C-statistics differed only numerically. Furthermore, our study showed that the instrument used to determine the level of symptoms in the GOLD 2011 classification has not only important consequences on the mortality prognosis, but also affects the morbidity prognosis in COPD. Therefore, patients' estimated prognosis could alter when different types of tools are used to evaluate the prognosis.
为了更好地对慢性阻塞性肺疾病（COPD）患者进行预后分类并调整治疗方案，慢性阻塞性肺疾病全球倡议组织（GOLD）2007年的分类标准于2011年进行了修订。当前数据分析的主要目的是评估GOLD 2007和2011年GOLD分类标准在一个详细描述的COPD队列中预测全因死亡率和发病率的准确性。在一项对795例COPD患者进行了3年随访的COPD死亡率和炎症队列（COMIC）研究中，评估了这两种GOLD分类标准以C统计量表示的预后价值。结局指标为全因死亡率和发病率。发病率定义为首次因COPD住院的时间以及首次社区获得性肺炎（CAP）的时间。比较了基于改良医学研究委员会（mMRC）评分的症状分类和具有两个不同阈值的临床COPD问卷（CCQ）评分的GOLD 2011分类标准的预后价值。尽管在我们的研究中GOLD 2011 CCQ分类标准在预测死亡率和发病率方面具有最高的准确性，但C统计量仅在数值上有所不同。此外，我们的研究表明，用于确定GOLD 2011分类标准中症状水平的工具不仅对死亡率预后有重要影响，而且还会影响COPD的发病率预后。因此，当使用不同类型的工具评估预后时，患者的估计预后可能会改变。
