Comparison of the 2017 and 2015 Global Initiative for Chronic Obstructive Lung Disease Reports Impact on Grouping and Outcomes
Comparison of the 2017 and 2015 Global Initiative for Chronic Obstructive Lung Disease Reports Impact on Grouping and Outcomes
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DOI：
10.1164/rccm.201707-1363oc
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发表时间：
2018-02-15
影响因子：
24.7
通讯作者：
Celli, Bartolome
中科院分区：
文献类型：
--
作者：
Cabrera Lopez, Carlos;Casanova Macario, Ciro;Celli, Bartolome
理由：慢性阻塞性肺疾病全球倡议 (GOLD) 文件修改了指导药物治疗的分级系统，但这与 2015 年的前一个分级系统以及合并症、住院治疗和死亡风险有何关系尚不清楚。 目的：本研究的目的是评估 2015 年至 2017 年 GOLD 组的变化，并评估每个组中对严重程度、合并症和死亡率的影响。方法：我们前瞻性地招募了西班牙和美国诊所的 819 名慢性阻塞性肺疾病患者（84% 为男性），并进行了平均 5 年的随访。我们测定了人体测量学、肺功能 (FEV1%)、呼吸困难评分（修订的医学研究委员会量表）、门诊和医院病情加重以及体重指数、阻塞、呼吸困难和运动能力 (BODE) 和查尔森指数。我们按照2015年和2017年的GOLD ABCD系统对患者进行分类，并比较同一患者的差异重新排列。我们将两种分类之间的 BODE 和 Charlson 分布以及慢性阻塞性肺疾病和全因死亡率重新分类的影响联系起来。测量和主要结果：与 2015 年相比，2017 年分级中 C 组和 D 组的患者比例减少了一半（20.5% vs. 11.2% 和 24.6% vs. 12.9%；P < 0.001）。查尔森的分布也发生了变化，2015年D组高于B组，2017年系统变得相似。 2017年，B级和D级的BODE指数和死亡风险高于A级和C级。2015年的死亡风险预测比2017年的系统更好。结论：与2015年相比，GOLD ABCD 2017分类将患者从C级和D级显着转移到A级和B级。新的分级系统使所有组中的Charlson合并症评分相等，并最大限度地减少了B 组和 D 组之间的 BODE，使得它们之间的死亡风险相似。
Rationale: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document has modified the grading system directing pharmacotherapy, but how this relates to the previous one from 2015 and to comorbidities, hospitalizations, and mortality risk is unknown.Objectives: The aim of this study was to evaluate the changes in the GOLD groups from 2015 to 2017 and to assess the impact on severity, comorbidities, and mortality within each group.Methods: We prospectively enrolled and followed, for a mean of 5 years, 819 patients with chronic obstructive pulmonary disease (84% male) in clinics in Spain and the United States. We determined anthropometrics, lung function (FEV1%), dyspnea score (modified Medical Research Council scale), ambulatory and hospital exacerbations, and the body mass index, obstruction, dyspnea, and exercise capacity (BODE) and Charlson indexes. We classified patients by the 2015 and 2017 GOLD ABCD system, and compared the differential realignment of the same patients. We related the effect of the reclassification in BODE and Charlson distribution as well as chronic obstructive pulmonary disease and all-cause mortality between the two classifications.Measurements and Main Results: Compared with 2015, the 2017 grading decreased by half the proportion of patients in groups C and D(20.5% vs. 11.2% and 24.6% vs. 12.9%; P < 0.001). The distribution of Charlson also changed, whereas group D was higher than B in 2015, they become similar in the 2017 system. In 2017, the BODE index and risk of death were higher in B and D than in A and C. The mortality risk was better predicted by the 2015 than the 2017 system.Conclusions: Compared with 2015, the GOLD ABCD 2017 classification significantly shifts patients from grades C and D to categories A and B. The new grading system equalizes the Charlson comorbidity score in all groups and minimizes the differences in BODE between groups B and D, making the risk of death similar between them.