Ogata Hiroaki, Tsubouchi Kazuya, Takano Tomotsugu, Ichiki Katsuyuki, Torii Ryo, Takata Shohei, Nakagaki Noriaki, Yoshida Makoto, Kitasato Yasuhiko, Tobino Kazunori, Harada Eiji, Wataya Hiroshi, Ishii Hiroshi, Maeyama Takashige, Kawasaki Masayuki, Fujita Masaki, Yatera Kazuhiro, Zaizen Yoshiaki, Nakanishi Yoichi, Okamoto Isamu
Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Kirigaoka Tsuda Hospital, Kitakyushu, Japan.
Sci Rep. 2025 May 30;15(1):19097. doi: 10.1038/s41598-025-05033-w.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, based on percent predicted forced expiratory volume in 1 s (ppFEV1), has been widely adopted for assessment of chronic obstructive pulmonary disease (COPD) severity. However, the STaging of Airflow obstruction by Ratio (STAR) system, based on the ratio of FEV1 to forced vital capacity, was recently proposed as an alternative classification. This study aimed to compare the prognostic performance of the GOLD and STAR classifications for prediction of mortality and exacerbation risk in individuals with COPD. This 5-year prospective, multicenter cohort study enrolled 370 individuals with COPD at 29 medical centers. All-cause mortality risk across GOLD and STAR stages was evaluated with Kaplan-Meier curves and Cox proportional hazards models. The risk of moderate to severe COPD exacerbations across GOLD and STAR stages was examined with cumulative incidence function (CIF) curves and Fine and Gray models. Both classification systems showed a significant association with mortality and exacerbation risk (P < 0.01 for trend). The GOLD classification provided a better separation of Kaplan-Meier and CIF curves for advanced stages, whereas the STAR classification showed a clearer distinction between stages I and II. These associations remained consistent after multivariable adjustments. The GOLD classification was superior for prediction of prognosis in advanced COPD, whereas the STAR classification provided better differentiation in early-stage disease. These findings highlight the complementary roles of the GOLD and STAR classifications in assessment of COPD severity.
基于1秒用力呼气容积预测值百分比（ppFEV1）的慢性阻塞性肺疾病全球倡议（GOLD）分类已被广泛用于评估慢性阻塞性肺疾病（COPD）的严重程度。然而，最近有人提出基于FEV1与用力肺活量比值的气流阻塞分期（STAR）系统作为一种替代分类方法。本研究旨在比较GOLD和STAR分类对COPD患者死亡率和急性加重风险预测的预后性能。这项为期5年的前瞻性多中心队列研究在29个医疗中心招募了370例COPD患者。采用Kaplan-Meier曲线和Cox比例风险模型评估GOLD和STAR各阶段的全因死亡风险。采用累积发病率函数（CIF）曲线和Fine and Gray模型研究GOLD和STAR各阶段中重度COPD急性加重的风险。两种分类系统均与死亡率和急性加重风险显著相关（趋势P < 0.01）。GOLD分类在晚期阶段的Kaplan-Meier曲线和CIF曲线分离效果更好，而STAR分类在I期和II期之间的区分更明显。多变量调整后，这些关联仍然一致。GOLD分类在晚期COPD预后预测方面更优，而STAR分类在早期疾病中具有更好的区分度。这些发现突出了GOLD和STAR分类在评估COPD严重程度方面的互补作用。
