1 Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain.
2 Respiratory Service, Hospital Universitario Nuestra Señora de la Candelaria, Canary Islands, Spain.
Am J Respir Crit Care Med. 2018 Feb 15;197(4):463-469. doi: 10.1164/rccm.201707-1363OC.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document has modified the grading system directing pharmacotherapy, but how this relates to the previous one from 2015 and to comorbidities, hospitalizations, and mortality risk is unknown.
The aim of this study was to evaluate the changes in the GOLD groups from 2015 to 2017 and to assess the impact on severity, comorbidities, and mortality within each group.
We prospectively enrolled and followed, for a mean of 5 years, 819 patients with chronic obstructive pulmonary disease (84% male) in clinics in Spain and the United States. We determined anthropometrics, lung function (FEV%), dyspnea score (modified Medical Research Council scale), ambulatory and hospital exacerbations, and the body mass index, obstruction, dyspnea, and exercise capacity (BODE) and Charlson indexes. We classified patients by the 2015 and 2017 GOLD ABCD system, and compared the differential realignment of the same patients. We related the effect of the reclassification in BODE and Charlson distribution as well as chronic obstructive pulmonary disease and all-cause mortality between the two classifications.
Compared with 2015, the 2017 grading decreased by half the proportion of patients in groups C and D (20.5% vs. 11.2% and 24.6% vs. 12.9%; P < 0.001). The distribution of Charlson also changed, whereas group D was higher than B in 2015, they become similar in the 2017 system. In 2017, the BODE index and risk of death were higher in B and D than in A and C. The mortality risk was better predicted by the 2015 than the 2017 system.
Compared with 2015, the GOLD ABCD 2017 classification significantly shifts patients from grades C and D to categories A and B. The new grading system equalizes the Charlson comorbidity score in all groups and minimizes the differences in BODE between groups B and D, making the risk of death similar between them.
全球慢性阻塞性肺疾病倡议（GOLD）文件已经修改了指导药物治疗的分级系统，但这与 2015 年的旧系统以及与合并症、住院和死亡风险的关系尚不清楚。
本研究旨在评估 2015 年至 2017 年 GOLD 组的变化，并评估每个组内严重程度、合并症和死亡率的变化。
我们前瞻性地招募并随访了 819 名在西班牙和美国诊所就诊的慢性阻塞性肺疾病患者（84%为男性），平均随访时间为 5 年。我们测定了人体测量学、肺功能（FEV%）、呼吸困难评分（改良的医学研究理事会量表）、门诊和住院加重情况以及体重指数、阻塞、呼吸困难和运动能力（BODE）和 Charlson 指数。我们根据 2015 年和 2017 年 GOLD ABCD 系统对患者进行分类，并比较了同一患者的差异重新分类。我们将重新分类对 BODE 和 Charlson 分布以及两种分类之间的慢性阻塞性肺疾病和全因死亡率的影响进行了关联。
与 2015 年相比，2017 年的分级将 C 和 D 组的患者比例减少了一半（20.5%比 11.2%和 24.6%比 12.9%；P<0.001）。Charlson 分布也发生了变化，2015 年 D 组高于 B 组，而 2017 年系统中两者相似。2017 年，B 和 D 组的 BODE 指数和死亡风险高于 A 和 C 组。2015 年系统比 2017 年系统更能预测死亡率风险。
与 2015 年相比，GOLD ABCD 2017 分类系统显著将患者从 C 级和 D 级转移到 A 级和 B 级。新的分级系统使所有组的 Charlson 合并症评分均等化，并使 B 和 D 组之间的 BODE 差异最小化，使它们之间的死亡风险相似。
