Criner Rachel N, Labaki Wassim W, Regan Elizabeth A, Bon Jessica M, Soler Xavier, Bhatt Surya P, Murray Susan, Hokanson John E, Silverman Edwin K, Crapo James D, Curtis Jeffrey L, Martinez Fernando J, Make Barry J, Han MeiLan K, Martinez Carlos H
Department of Internal Medicine, University of Michigan, Ann Arbor.
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.
Chronic Obstr Pulm Dis. 2019 Jan 10;6(1):64-73. doi: 10.15326/jcopdf.6.1.2018.0130.
The Global initiative for chronic Obstructive Lung Disease (GOLD) ABCD groupings were recently modified. The GOLD 2011 guidelines defined increased risk as forced expiratory volume in 1 second (FEV) < 50% predicted or ≥ 2 outpatient or ≥ 1 hospitalized exacerbation in the prior year, whereas the GOLD 2017 guidelines use only exacerbation history. We compared mortality and exacerbation rates in the Genetic Epidemiology of COPD Study cohort (COPDGene) by 2011 (exacerbation history/FEV and dyspnea) versus 2017 (exacerbations and dyspnea) classifications. Using data from COPDGene, we tested associations of ABCD groups with all-cause mortality (Cox models, adjusted for age, sex, race and comorbidities) and longitudinal exacerbations (zero-inflated Poisson models). In 4469 individuals (mean age 63.1 years, 44% female), individual distributions in 2011 versus 2017 systems were: A, 32.0% versus 37.0%; B, 17.6% versus 36.3%; C, 9.4% versus 4.4%; D, 41.0% versus 22.3%; (observed agreement 76% [expected 27.8%], Kappa 0.67, <0.001). Individuals in group D-2011 had 1.1 ± 1.6 exacerbations/year (mean ± standard deviation [SD]) versus 1.4 ± 1.8 for D-2017 (median follow-up 3.7 years). Using group A as reference, for both systems, mortality (median follow-up 6.8 years) was highest in group D (D-2011, [hazard ratio] HR 5.2 [95% confidence interval (CI) 4.2, 6.4]; D-2017, HR 5.5 [4.5, 6.8]), lowest for group C (HR 1.9 [1.4, 2.6] versus HR 1.9 [1.3, 2.8]) and intermediate for group B (HR 2.6 [2.0, 3.4] versus HR 3.4 [2.8, 4.1]). GOLD 2011 had better mortality discrimination (area under the curve [AUC] 0.68) than GOLD 2017 (AUC 0.66, <0.001 for comparison) but similar exacerbation rate prediction. Relative to the GOLD 2011 consensus statement, discriminate predictive power of the 2017 ABCD classification is similar for exacerbations but lower for survival.
慢性阻塞性肺疾病全球倡议组织（GOLD）的ABCD分组最近进行了修订。2011年GOLD指南将风险增加定义为1秒用力呼气容积（FEV）低于预测值的50%或前一年门诊就诊≥2次或住院加重≥1次，而2017年GOLD指南仅采用加重病史。我们通过2011年（加重病史/FEV和呼吸困难）与2017年（加重和呼吸困难）分类比较了慢性阻塞性肺疾病基因研究队列（COPDGene）中的死亡率和加重率。利用COPDGene的数据，我们测试了ABCD组与全因死亡率（Cox模型，校正年龄、性别、种族和合并症）以及纵向加重（零膨胀泊松模型）之间的关联。在4469名个体（平均年龄63.1岁，44%为女性）中，2011年与2017年系统中的个体分布情况为：A组，32.0%对37.0%；B组，17.6%对36.3%；C组，9.4%对4.4%；D组，41.0%对22.3%；（观察一致性76%[预期27.8%]，Kappa值0.67，P<0.001）。2011年D组个体每年有1.1±1.6次加重（平均值±标准差[SD]），而2017年D组为1.4±1.8次（中位随访3.7年）。以A组为参照，对于两个系统，死亡率（中位随访6.8年）在D组最高（2011年D组，风险比[HR]5.2[95%置信区间（CI）4.2,6.4]；2017年D组，HR5.5[4.5,6.8]），C组最低（HR1.9[1.4,2.6]对HR1.9[1.3,2.8]），B组居中（HR2.6[2.0,3.4]对HR3.4[2.8,4.1]）。2011年GOLD在死亡率鉴别方面（曲线下面积[AUC]0.68）优于2017年GOLD（AUC0.66，比较P<0.001），但在加重率预测方面相似。相对于2011年GOLD共识声明，2017年ABCD分类在加重方面的鉴别预测能力相似，但在生存方面较低。
