Prediction of Hospitalization and Mortality in Patients with Chronic Obstructive Pulmonary Disease with the New Global Initiative for Chronic Obstructive Lung Disease 2023 Group Classification: A Prospective Cohort and a Retrospective Analysis

Abstract

Background

The revised Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 group ABE classification has undergone major modifications, which can simplify clinical assessment and optimize treatment recommendations for Chronic Obstructive Pulmonary Disease (COPD). However, the predictive value of the new grouping classification for prognosis is worth further exploration. We aimed to compare the prediction of hospitalization and mortality between this new GOLD group 2023 ABE classification and the earlier 2017 ABCD classification in a Chinese COPD cohort.

Methods

Data from 2,499 outpatients with COPD, who first registered in the RealDTC study of Second Xiangya Hospital from December 2016 to December 2019, were collected prospectively and assessed retrospectively. Patients were followed up on all-cause mortality until October 2022 or death.

Results: 

Of the 2,499 patients with COPD, the risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The mortality was higher in group E than in groups A and B, and group B was higher than group A. No differences were seen in the area under the curve (AUC) of 2017 vs 2023 GOLD grouping to predict hospitalization. The time-dependent AUC and concordance index for predicting mortality is slightly higher in the GOLD 2017 ABCD than in the 2023 ABE groups. The new GOLD 12-subgroup (1A–4E) classification combining the GOLD 1–4 staging and grouping performed similarly discriminate predictive power for mortality to the GOLD 2017 16-subgroup (A1–4D) classification.

Conclusion

The risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The all-cause mortality increased gradually from GOLD group A to E. The GOLD 2023 classification based on ABE groups did not predict mortality better than the earlier 2017 ABCD classifications.

Keywords:

• COPD
• mortality
• hospitalization
• GOLD 2023

Abbreviations

GOLD, Global Initiative for Chronic Obstructive Lung Disease; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second divided; FVC, forced vital capacity; BMI, body mass index; CAT, COPD assessment test; mMRC, modified Medical Research Council; AE, acute exacerbation; OR, odds ratio; HR, hazard ratio; CI, confidence intervals; ROC, receiver operating characteristic; AUC, area under the receiver operating characteristic curve; NRI, net reclassification index; IDI, integrated discrimination improvement; C-index, concordance index.

Data Sharing Statement

The data that support the findings of this study are available upon reasonable request from the first author.

Ethics Approval and Informed Consent

All procedures followed were in accordance with the Helsinki Declaration. This study was approved by the local Ethics Committee of Second Xiangya Hospital of Central South University. All participants had signed the informed consent form.

Acknowledgments

We gratefully thank research assistant Zhiwen Wang, research assistant Guolin Zhong, Dr. Chujuan Tang, Dr. Xiao Liu, and Dr. Xueshan Li of Second Xiangya Hospital for their contribution to the data collection and regular follow-up of patients.

Author Contributions

All authors contributed to data analysis, drafting, or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (NSFC, Grants 81970044), (NSFC, Grants 82270045), and (NSFC, Grants 82001490).