Science and Research

GOLD COPD Exacerbation History Categories and Disease Outcomes

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.

  • Waeijen-Smit, K.
  • Peerlings, D. E. M.
  • Jörres, R. A.
  • Watz, H.
  • Bals, R.
  • Rabe, K. F.
  • Vogelmeier, C. F.
  • Speicher, T.
  • Spruit, M. A.
  • Simons, S. O.
  • Houben-Wilke, S.
  • Franssen, F. M. E.
  • Alter, P.

Keywords

  • Humans
  • *Pulmonary Disease, Chronic Obstructive/mortality/physiopathology
  • Male
  • Female
  • Aged
  • Middle Aged
  • *Disease Progression
  • *Severity of Illness Index
  • Cohort Studies
  • Germany/epidemiology
  • Forced Expiratory Volume
Publication details
DOI: 10.1001/jamanetworkopen.2024.45488
Journal: JAMA Netw Open
Pages: e2445488 
Number: 12
Work Type: Original
Location: ARCN, UGMLC
Disease Area: COPD
Partner / Member: CAU, Ghd, UMR
Access-Number: 39693071

DZL Engagements

chevron-down