Department of Research and Education, CIRO, Horn, The Netherlands.
Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
J Am Med Dir Assoc. 2017 Dec 1;18(12):1097.e11-1097.e24. doi: 10.1016/j.jamda.2017.09.003.
Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.
After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.
Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.
A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.
The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.
根据症状强度，慢性阻塞性肺疾病（COPD）患者可分为 A/C 或 B/D 组。症状问卷的不同阈值可能导致分类错误，并进而导致不同的治疗建议。主要目的是找到 Global initiative for chronic Obstructive Lung Disease（GOLD）症状测量的最佳拟合切点，以改良的 Medical Research Council 呼吸困难等级 2 或更高为参考点。
在计算机检索后，对同意提供数据的 41 个队列的数据进行了汇总。如果 COPD 研究包括至少年龄、性别、支气管扩张后肺量测定、改良 Medical Research Council 呼吸困难量表和 COPD 评估测试（CAT）总分，则符合分析条件。
使用受试者工作特征曲线和 Youden 指数来确定 CAT、COPD 临床问卷和圣乔治呼吸问卷总分的最佳校准阈值。随后，根据当前切点和新切点计算 GOLD A/B/C/D 的频率。
共分析了 18577 例 COPD 患者[72.0%为男性；平均年龄 66.3 岁（标准差 9.6）]。大多数患者存在中重度气流受限（GOLD 肺功能分级 1 级 10.9%；2 级 46.6%；3 级 32.4%；4 级 10.3%）。CAT 总分的最佳校准阈值为 18 分，COPD 临床问卷总分为 1.9 分，圣乔治呼吸问卷总分为 46.0 分。
应用这些新切点将重新分类约三分之一的 COPD 患者，从而影响个体疾病管理。需要进一步在前瞻性研究中验证这些新值。
