Prognostic Properties of the GOLD 2023 Classification System

Int J Chron Obstruct Pulmon Dis. 2023 Apr 20:18:661-667. doi: 10.2147/COPD.S410372. eCollection 2023.

Abstract

Introduction: Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published an update on the Global Strategy for Prevention, Diagnosis and Management of COPD, introducing a new classification of chronic obstructive pulmonary disease (COPD). Our aim was to assess the prognostic value of the new GOLD classification system in comparison with the previous GOLD classification systems (GOLD stages I-IV and GOLD groups A-D) and the BODE index.

Methods: We used the data of 784 patients with COPD from the Czech Multicenter Research Database of COPD. Patient survival was analyzed with the use of Kaplan-Meier estimate and Cox model of proportional risks. ROC analysis and area under curve (AUC) were used for comparison of GOLD classifications and BODE index. The analyses were performed with the use of software R (version 4.2.0).

Results: We analyzed data of 782 patients with complete data on GOLD classifications. The study population comprised 72.9% of men, 89.1% current or former smokers, with a mean age of 66.6 years, a mean BMI of 27.4 and a mean FEV1 44.9% of predicted. Probability of 5-year survival differed by GOLD classification. Application of the 2023 GOLD classification showed increased risk of death in group B (HR 1.82, 95% CI 1.14-2.92; p = 0.013) and in group E (HR 2.48, 95% CI 1.54-3.99; p˂0.001). The ROC analysis showed that the overall prognostic value of the 2023 GOLD classification was similarly weak to previous A-D GOLD classification schemes (AUCs 0.557-0.576) and was lower compared to the GOLD 1-4 system (AUC 0.614) and even lower when compared to the BODE index (AUC 0.715).

Conclusion: We concluded that the new GOLD classification system has poor prognostic properties and that specific prediction tools (eg, the BODE index) should be used for mortality risk assessment.

Keywords: COPD; GOLD classification; mortality; prognosis.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Disease Progression
  • Humans
  • Male
  • Prognosis
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Risk Assessment
  • Severity of Illness Index

Grants and funding

Supported by the Czech Pneumological and Phthisiological Society (open access publication fee grant). The CMRD research project was funded by the Ministry of Health of the Czech Republic (MH CZ‐DRO FNBr 65269705), and a consortium of pharmaceutical companies (Sandoz, Novartis, GSK, CSL Behring, Cipla, Boehringer Ingelheim, AstraZeneca, and Angelini). The companies supported the CMRD project via unrestricted research grants. The supporters had no role in the study design, data analysis or in preparation of the manuscript. All opinions, results, and conclusions reported in this paper are independent from the sponsors.