Comparison of STAR and GOLD in Assessing Disease Severity Among High-Risk and COPD Patients: Evidence from Enjoying Breathing Program in China

Int J Chron Obstruct Pulmon Dis. 2024 Dec 27:19:2751-2762. doi: 10.2147/COPD.S492178. eCollection 2024.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: COPD; GOLD; STAR; disease severity.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • China / epidemiology
  • Disease Progression
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung* / physiopathology
  • Male
  • Middle Aged
  • Predictive Value of Tests*
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / physiopathology
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index*
  • Vital Capacity

Grants and funding

CAMS Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-B-107 and 2021-I2M-1-049), National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-0107), National Natural Science Foundation of China (82100044) and Elite Medical Professionals Project of China-Japan Friendship Hospital (NO.ZRJY2024-GG06 and NO.ZRJY2021-QM10).