Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease.
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Smid Dionne E, Franssen Frits M E, Gonik Maria, Miravitlles Marc, Casanova Ciro, Cosio Borja G, de Lucas-Ramos Pilar, Marin Jose M, Martinez Cristina, Mir Isabel, Soriano Joan B, de Torres Juan P, Agusti Alvar, Atalay Nart B, Billington Julia, Boutou Afroditi K, Brighenti-Zogg Stefanie, Chaplin Emma, Coster Samantha, Dodd James W, Dürr Selina, Fernandez-Villar Alberto, Groenen Miriam T J, Guimarães Miguel, Hejduk Karel, Higgins Victoria, Hopkinson Nicholas S, Horita Nobuyuki, Houben-Wilke Sarah, Janssen Daisy J A, Jehn Melissa, Joerres Rudolf, Karch Annika, Kelly Julia L, Kim Yu-Il, Kimura Hiroshi, Koblizek Vladimir, Kocks Janwillem H, Kon Samantha S C, Kwon Namhee, Ladeira Inês, Lee Sang-Do, Leuppi Joerg D, Locantore Nicholas, Lopez-Campos José L, D-C Man William, Maricic Lana, Mendoza Laura, Miedinger David, Mihaltan Florin, Minami Seigo, van der Molen Thys, Murrells Trevor J, Nakken Nienke, Nishijima Yu, Norman Ian J, Novotna Barbora, O'Donnell Denis E, Ogata Yoshitaka, Pereira Eanes D, Piercy James, Price David, Pothirat Chaicharn, Raghavan Natya, Ringbaek Thomas, Sajkov Dimitar, Sigari Naseh, Singh Sally, Small Mark, da Silva Guilherme F, Tanner Rebecca J, Tsiligianni Ioanna G, Tulek Baykal, Tzanakis Nikolaos, Vanfleteren Lowie E G W, Watz Henrik, Webb Katherine A, Wouters Emiel F M, Xie Guogang G, Yoshikawa Masanori, Spruit Martijn A
Аннотация
METHODS: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.
MAIN OUTCOMES: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.
FINDINGS: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.
CONCLUSIONS: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.