Huang Ke, Tang Xingyao, Chu Xu, Niu Hongtao, Li Wei, Zheng Zhoude, Peng Yaodie, Lei Jieping, Li Yong, Li Baicun, Yang Ting, Wang Chen
Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People's Republic of China.
Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Dec 27;19:2751-2762. doi: 10.2147/COPD.S492178. eCollection 2024.
The STAR staging standard has been demonstrated to have good performance in distinguishing mortality among patients at different stages. However, the effectiveness of STAR and GOLD staging in distinguishing disease severity in high-risk and COPD patients remained unclear.
Based on Enjoying Breathing Program data through June 2023, a total of 7.924 high-risk and COPD patients were included. STAR and GOLD severity stages were based on FEV1/FVC (0.6-0.7, 0.5-0.6, 0.4-0.5, and <0.4 for stage 1 to 4 in STAR) and the proportion of predicted FEV1 value (≥80%, 50%-80%, 30%-50%, and <30% for stage 1 to 4 in GOLD), respectively. The cox regression model was used to assess the risk of medical visit due to severe respiratory symptoms according to STAR and GOLD.
The current study included 1603 high-risk individuals and 6321 COPD patients. The proportions of STAR 1-4 in COPD patients were 37.1%, 33.2%, 20.5%, and 9.2%, respectively. In COPD patients only, GOLD stage distinguished disease severity well, but there was no difference in the risk of exacerbation between the different STAR stage groups. In addition, in COPD patients, by considering of GOLD and STAR together, GOLD 3 and 4 can provide more information about the exacerbation based on each STAR level, and STAR 1 and 2 can provide more information about the exacerbation in GOLD 2-4. COPD patients with GOLD 4 and STAR 2 (HR=4.08, 95% CI: 2.75-6.04) had the highest risk of exacerbation, followed by COPD patients with GOLD 4 and STAR 1 (HR=3.94, 95% CI: 2.49-6.23).
In COPD patients, GOLD performs better than STAR in predicting exacerbation risk. In addition, the combination of GOLD and STAR can provide more information, especially for COPD patients with GOLD 4 and STAR 1-2, which should be paid more attention in treatment and disease management.
STAR分期标准已被证明在区分不同阶段患者的死亡率方面表现良好。然而，STAR和GOLD分期在区分高危和慢性阻塞性肺疾病（COPD）患者疾病严重程度方面的有效性仍不明确。
基于截至2023年6月的“享受呼吸计划”数据，共纳入7924例高危和COPD患者。STAR和GOLD严重程度分期分别基于第一秒用力呼气容积（FEV1）/用力肺活量（FVC）（STAR分期1至4期分别为0.6 - 0.7、0.5 - 0.6、0.4 - 0.5和<0.4）以及预测FEV1值的比例（GOLD分期1至4期分别为≥80%、50% - 80%、30% - 50%和<30%）。采用Cox回归模型根据STAR和GOLD评估因严重呼吸道症状就诊的风险。
本研究纳入1603例高危个体和6321例COPD患者。COPD患者中STAR 1至4期的比例分别为37.1%、33.2%、20.5%和9.2%。仅在COPD患者中，GOLD分期能很好地区分疾病严重程度，但不同STAR分期组之间的急性加重风险无差异。此外，在COPD患者中，综合考虑GOLD和STAR，GOLD 3和4期基于每个STAR水平可提供更多关于急性加重的信息，而STAR 1和2期可在GOLD 2至4期提供更多关于急性加重的信息。GOLD 4期和STAR 2期的COPD患者（风险比[HR]=4.08，95%置信区间[CI]：2.75 - 6.04）急性加重风险最高，其次是GOLD 4期和STAR 1期的COPD患者（HR = 3.94，95% CI：2.49 - 6.23）。
在COPD患者中，GOLD在预测急性加重风险方面比STAR表现更好。此外，GOLD和STAR的联合可提供更多信息，特别是对于GOLD 4期和STAR 1至2期的COPD患者，在治疗和疾病管理中应给予更多关注。
