Ambrosino Pasquale, Vitacca Michele, Marcuccio Giuseppina, Spanevello Antonio, Ambrosino Nicolino, Maniscalco Mauro
Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese Terme, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Lumezzane Institute, Lumezzane, Italy.
Chest. 2025 Feb;167(2):387-401. doi: 10.1016/j.chest.2024.10.013. Epub 2024 Oct 19.
Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the Staging of Airflow Obstruction by Ratio (STAR) severity scheme has been proposed for categorizing COPD.
What are the agreement and utility of the GOLD and STAR classifications in patients with severe COPD entering the rehabilitation setting?
Medical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of patients with COPD undergoing pulmonary rehabilitation.
A total of 1,516 participants (33.7% female participants; median age, 72.0 years) were included in the analysis. Compared with GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's kappa of 0.25 and a Bangdiwala B value of 0.24 indicated a fair agreement between the 2 classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD exhibited superior discrimination between stages for chronic respiratory failure, whereas STAR exhibited better performance in detecting hyperinflation. In terms of their application within pulmonary rehabilitation settings, GOLD exhibited superior performance compared with STAR in identifying the minimal clinically important difference in 6-min walking distance and modified Medical Research Council score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a minimal clinically important difference in modified Medical Research Council score (OR, 1.48; 95% CI, 1.12-1.94; P = .005) and also independently predicted changes in the Braden scale score (β = 0.154; P = .004).
STAR exhibited a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation, but our preliminary findings do not endorse its utilization in the rehabilitation setting.
除了公认的慢性阻塞性肺疾病全球倡议（GOLD）分类外，还提出了按比例划分气流阻塞分期（STAR）严重程度方案用于慢性阻塞性肺疾病的分类。
GOLD和STAR分类在进入康复治疗的重度慢性阻塞性肺疾病患者中的一致性和实用性如何？
在这项多中心回顾性研究中，对病历进行了审查，检查了一大群接受肺康复治疗的慢性阻塞性肺疾病患者的关键功能变量及其变化。
共有1516名参与者（33.7%为女性参与者；中位年龄72.0岁）纳入分析。与GOLD相比，53.4%的患者使用STAR分类得出的疾病严重程度类别不同。未加权的科恩kappa系数为0.25，邦迪瓦拉B值为0.24，表明两种分类之间有中等程度的一致性。更高的加权一致性测量值（分别为0.47和0.78）表明分类之间的差异主要发生在相邻阶段。GOLD在慢性呼吸衰竭各阶段之间表现出更好的区分度，而STAR在检测肺过度充气方面表现更佳。就其在肺康复环境中的应用而言，在识别6分钟步行距离和改良医学研究委员会评分的最小临床重要差异方面，GOLD比STAR表现更优。因此，GOLD而非STAR是改良医学研究委员会评分达到最小临床重要差异的独立预测因素（OR，1.48；95%CI，1.12 - 1.94；P = 0.005），并且还能独立预测布拉德恩量表评分的变化（β = 0.154；P = 0.004）。
STAR在疾病严重程度分级上更为均匀，在检测肺过度充气方面表现更佳，但我们的初步研究结果不支持在康复环境中使用它。
