Prognostic Properties of the GOLD 2023 Classification System
Kristian Brat1,2,3, Michal Svoboda4, Jaromir Zatloukal5,6
1Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.
Summary
The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification for COPD has poor prognostic value. For accurate mortality risk assessment in COPD patients, the BODE index is recommended over newer GOLD guidelines.
Area of Science:
- Pulmonology
- Clinical Medicine
- Respiratory Disease Research
Background:
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recently updated its strategy, introducing a new COPD classification.
- Previous GOLD classifications (stages I-IV, groups A-D) and the BODE index are established prognostic tools for COPD.
Purpose of the Study:
- To evaluate the prognostic capability of the newest GOLD COPD classification.
- To compare the new GOLD classification's predictive accuracy against prior GOLD systems and the BODE index.
Main Methods:
- Analysis of survival data from 782 patients with chronic obstructive pulmonary disease (COPD) from a Czech multicenter database.
- Kaplan-Meier and Cox proportional hazards models were used for survival analysis.
- Receiver Operating Characteristic (ROC) analysis and Area Under the Curve (AUC) compared the prognostic performance of different GOLD classifications and the BODE index.
Main Results:
- The 2023 GOLD classification identified increased mortality risk in groups B (HR 1.82) and E (HR 2.48).
- ROC analysis revealed weak prognostic value for the 2023 GOLD classification (AUCs 0.557-0.576), similar to previous A-D schemes.
- The BODE index demonstrated superior prognostic accuracy (AUC 0.715) compared to all GOLD classification systems.
Conclusions:
- The latest GOLD COPD classification system exhibits limited prognostic ability.
- The BODE index remains a more reliable tool for assessing mortality risk in patients with chronic obstructive pulmonary disease.
