New GOLD no better than old GOLD at predicting mortality

Thursday, 21 May 2015

Both GOLD classification systems are unable to predict mortality in COPD patients at an individual level, an analysis of data from 22 studies involving over 15,000 patients finds.

Neither the 2007 or the enhanced 2011 classification system had sufficient discriminatory power to be used clinically for risk classification at the individual level to predict total mortality for three years of follow-up or up to 10 years, the analysis published in The Lancet Respiratory Medicine found.

While both classification schemes were significantly related to total mortality up to 10 years neither had a striking discriminatory power with AUCs ranging from 0.62 to 0.65.

“The more complicated GOLD 2011 classification scheme is no better than the simpler previous one based on spirometry only,” said the study authors led by Joan Soriano from University of Madrid in Spain.

The classification schemes might be useful to guide therapy but are unlikely to be clinically useful to identify patients at high risk of mortality, even in the short term, they said.

The research team says another important finding was that in the 2011 GOLD classification little difference was found between categorisation in classes B and C within the first three years of follow-up.

“Our data provide additional support that Class C might be superfluous given that within this pooled analysis fewer than 1835 of 15632 (12%) of patients with COPD fit into this category and little difference exists in the treatment strategies between classes B and C,” they wrote.

The use of the 2011 staging system also resulted in many more patients with the most severe disease.

“This change has the potential to increase therapeutic intensity in these patients, which might have important economic clinical impact,” they said.

“It remains to be seen whether this change will effectively improve health outcomes,” they concluded.




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