ORCID: https://orcid.org/0000-0002-9782-1117; Watz, Henrik; Bals, Robert; Rabe, Klaus F.; Vogelmeier, Claus F.; Speicher, Tim; Spruit, Martijn A.; Simons, Sami O.; Houben-Wilke, Sarah; Franssen, Frits M. E. und Alter, Peter
(18. Dezember 2024):
GOLD COPD Exacerbation History Categories and Disease Outcomes.
In: JAMA Network Open, Bd. 7, Nr. 12, e2445488
[PDF, 1MB]

Abstract
Importance: Previous exacerbations of chronic obstructive pulmonary disease (ECOPD) are associated with future events. For more than a decade, patients at high risk have been defined as individuals with a history of 2 or more moderate ECOPD, 1 or more severe ECOPD, or both within 12 months, and treatments have been allocated accordingly, but these cutoffs lack validation.
Objectives: To validate ECOPD history categories by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and explore alternative cutoffs to estimate moderate and severe ECOPD and all-cause mortality in COPD.
Design, Setting, and Participants: This cohort study analyzed data from patients with COPD in the German COPD and Systemic Consequences-Comorbidities Network (COSYCONET) study. Patients were recruited from September 2010 to December 2013. Analyses were conducted in September 2023 to August 2024.
Main Outcomes and Measures: Risk of moderate and severe (ie, with hospitalization) ECOPD and all-cause mortality over a 4.5-year follow-up period were assessed using binomial logistic regressions and area under the receiver operating characteristic curves (AUROCs) with 95% CIs.
Results: Among 2291 patients with COPD GOLD categories 1 to 4 (mean [SD] age, 65 [8] years; 1396 male [60.9%]), the mean (SD) estimated forced expiratory volume in the first second of expiration was 52.5% (18.6%). ECOPD history categories by GOLD had an AUROC of 0.63 (95% CI, 0.60-0.65) and 0.62 (95% CI, 0.58-0.66) to estimate moderate and severe ECOPD, respectively. A single previous moderate ECOPD within 12 months more accurately estimated future moderate and severe ECOPD (AUROC, 0.66; 95% CI, 0.64-0.69), and in line with GOLD, 1 previous severe ECOPD within 12 months estimated moderate and severe ECOPD (AUROC, 0.63; 95% CI, 0.60-0.67). The 4-year mortality rate was 219 patients (9.6%). Patients with 3 or more previous moderate ECOPD (odds ratio, 2.18; 95% CI, 1.27-3.72) or 1 or more previous severe ECOPD (odds ratio, 1.57; 95% CI, 1.29-1.91) within 12 months were more likely to die compared with patients without prior ECOPD.
Conclusions and Relevance: This study’s findings suggest a limited estimative performance of ECOPD history categories by GOLD. Novel cutoffs were suggested, categorizing patients as without exacerbations or with high-risk exacerbations based on a history of 1 or more moderate ECOPD, 1 or more severe ECOPD, or both within 12 months.
Dokumententyp: | Zeitschriftenartikel |
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Fakultät: | Medizin > Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie |
Themengebiete: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit |
URN: | urn:nbn:de:bvb:19-epub-124990-1 |
ISSN: | 2574-3805 |
Sprache: | Englisch |
Dokumenten ID: | 124990 |
Datum der Veröffentlichung auf Open Access LMU: | 28. Apr. 2025 12:03 |
Letzte Änderungen: | 28. Apr. 2025 12:03 |