Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China.
Chin Med J (Engl). 2023 Nov 5;136(21):2587-2595. doi: 10.1097/CM9.0000000000002487.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 proposed a new classification that reclassified many chronic obstructive pulmonary disease (COPD) patients from group D to B. However, there is a paucity of data related to the comparison between reclassified and non-reclassified COPD patients in terms of long-term prognosis. This study aimed to investigate long-term outcomes of them and determine whether the GOLD 2017 revision improved the assessment of COPD patients.
This observational, multicenter, prospective study recruited outpatients at 12 tertiary hospitals in China from November 2016 to February 2018 and followed them up until February 2022. All enrolled patients were classified into groups A to D based on GOLD 2017, and the subjects in group B included patients reclassified from group D to B (group DB) and those remaining in group B (group BB). Incidence rates and hazard ratios (HRs) were calculated for the exacerbation of COPD and hospitalization in each group.
We included and followed up 845 patients. During the first year of follow-up, the GOLD 2017 classification had a better discrimination ability for different risks of COPD exacerbation and hospitalization than GOLD 2013. Group DB was associated with a higher risk of moderate-to-severe exacerbation (HR = 1.88, 95% confidence interval [CI] = 1.37-2.59, P <0.001) and hospitalization for COPD exacerbation (HR = 2.23, 95% CI = 1.29-3.85, P = 0.004) than group BB. However, during the last year of follow-up, the differences in the risks of frequent exacerbations and hospitalizations between group DB and BB were not statistically significant (frequent exacerbations: HR = 1.02, 95% CI = 0.51-2.03, P = 0.955; frequent hospitalizations: HR = 1.66, 95% CI = 0.58-4.78, P = 0.348). The mortality rates of the two groups were both approximately 9.0% during the entire follow-up period.
The long-term prognosis of patients reclassified into group B and of those remaining in group B was similar, although patients reclassified from group D to group B had worse short-term outcomes. The GOLD 2017 revision could improve the assessment of Chinese COPD patients in terms of long-term prognosis.
全球慢性阻塞性肺疾病倡议（GOLD）2017 年提出了一种新的分类方法，将许多慢性阻塞性肺疾病（COPD）患者从 D 组重新分类为 B 组。然而，关于重新分类和未重新分类 COPD 患者的长期预后比较的数据很少。本研究旨在探讨他们的长期结局，并确定 GOLD 2017 修订是否改善了 COPD 患者的评估。
这是一项观察性、多中心、前瞻性研究，于 2016 年 11 月至 2018 年 2 月在中国的 12 家三级医院招募门诊患者，并随访至 2022 年 2 月。所有纳入的患者均根据 GOLD 2017 进行分组，B 组包括从 D 组重新分类为 B 组的患者（DB 组）和仍留在 B 组的患者（BB 组）。计算每组 COPD 恶化和住院的发生率和风险比（HR）。
我们纳入并随访了 845 名患者。在随访的第一年，GOLD 2017 分类对 COPD 恶化和住院的不同风险的区分能力优于 GOLD 2013。DB 组与中度至重度恶化的风险较高相关（HR=1.88，95%置信区间[CI]1.37-2.59，P<0.001）和 COPD 恶化住院（HR=2.23，95%CI1.29-3.85，P=0.004）比 BB 组。然而，在随访的最后一年，DB 组和 BB 组之间频繁恶化和住院的风险差异没有统计学意义（频繁恶化：HR=1.02，95%CI0.51-2.03，P=0.955；频繁住院：HR=1.66，95%CI0.58-4.78，P=0.348）。两组在整个随访期间的死亡率均约为 9.0%。
重新分类为 B 组和留在 B 组的患者的长期预后相似，尽管从 D 组重新分类为 B 组的患者短期预后较差。GOLD 2017 修订可以改善中国 COPD 患者的长期预后评估。
