Validation of exacerbation history grading by GOLD for predicting future COPD outcomes

Peerlings, Daphne; Waeijen-Smit, Kiki; Jörres, Rudolf A. ; Watz, Henrik; Bals, Robert; Welte, Tobias ; Rabe, Klaus F. ; Vogelmeier, Claus F. ; Speicher, Tim; Spruit, Martijn A. ; Simons, Sami O.; Houben-Wilke, Sarah; Franssen, Frits M. E. und Alter, Peter (2024): Validation of exacerbation history grading by GOLD for predicting future COPD outcomes. In: European Respiratory Journal, Bd. 64, Nr. Suppl. 68, OA4647

Abstract

Background: Individuals with COPD often experience exacerbations (ECOPD). For over a decade, high ECOPD risk is stratified according to a history of ≥2 moderate ECOPD and/or ≥1 severe ECOPD in <12 months. To date, these cutoffs lack validation.

Objectives: To validate the ECOPD history frequency cutoff values suggested by GOLD, and to explore potential other cutoff strategies to predict ECOPD and all-cause mortality.

Methods: Data from patients with COPD of the German COSYCONET cohort study were analyzed. Risk of ECOPD, hospitalizations and all-cause mortality during 4.5 years were assessed using binomial logistic regressions, and area under the ROC curves (AUC-ROC) with 95% confidence intervals (CI).

Results: 2,291 patients with COPD GOLD 1-4 (mean age 65±8 years, 61% male, FEV1 53±19% predicted) were included. ECOPD history cutoff points by GOLD showed an AUC of 0.63 (95% CI 0.60-0.65) and 0.62 (95% CI 0.58-0.66) to predict ECOPD and hospitalizations, respectively. One previous ECOPD <12 months (AUC 0.66, 95% CI 0.64-0.69) more accurately predicted ECOPD and hospitalizations, and in line with GOLD, one previous hospitalization <12 months (AUC 0.63, 95% CI 0.60-0.67) predicted ECOPD and hospitalizations. The 4-year mortality rate was 9.6%. Patients with ≥3 previous ECOPD or ≥1 previous hospitalizations in <12 months were 2.18 (95% CI 1.27-3.72) and 1.57 (95% CI 1.29-1.91) times more likely to die, respectively.

Conclusions: This study highlights the limited predictive performance of the current COPD risk assessment by GOLD. Novel cutoffs were suggested, categorizing patients as non-exacerbators or high-risk exacerbators based on a history of ≥1 ECOPD and/or ≥1 hospitalization <12 months.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch