Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
Int J Chron Obstruct Pulmon Dis. 2020 Jan 31;15:225-233. doi: 10.2147/COPD.S228958. eCollection 2020.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality.
We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995-1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications.
Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (p=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time.
The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.
全球慢性阻塞性肺疾病倡议（GOLD）自 2007 年至 2017 年已发布了三种 COPD 分类。目前尚无研究调查这些分类对 COPD 相关住院的预测能力。我们旨在比较 GOLD 2007、2011 和 2017 分类对预测 COPD 住院和全因死亡率的区分能力。
我们对参加 1995-1997 年 HUNT 研究的年龄≥40 岁的 1300 例 COPD 患者进行了随访，直至 2015 年 12 月 31 日。采用生存分析和时间依赖性受试者工作特征曲线（AUC）下面积比较 GOLD 分类的区分能力。
在 1300 名患者中，522 人因 COPD 住院，896 人在 20.4 年的随访期间死亡。在调整后的模型中，GOLD 2007、GOLD 2011 或 GOLD 2017 类别的恶化与 COPD 住院和全因死亡率的风险增加相关，但 GOLD 2017 分类和全因死亡率除外（p=0.114）。在原始模型中，GOLD 2007、GOLD 2011 和 GOLD 2017 对 COPD 住院的 AUC（95%CI）分别为 63.1（58.7-66.9）、60.9（56.1-64.4）和 56.1（54.0-58.1），在 20 年的随访中。全因死亡率的相应估计值分别为 57.0（54.8-59.1）、54.1（52.1-56.0）和 52.6（51.0-54.3）。在 COPD 住院和全因死亡率的预测中，GOLD 分类之间 AUC 的差异在随访期间保持不变。
与 GOLD 2011 和 2017 分类相比，GOLD 2007 分类在预测 COPD 住院和全因死亡率方面更好。
