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Original Research: Copd |

Distribution and Prognostic Validity of the New Global Initiative for Chronic Obstructive Lung Disease Grading ClassificationNew GOLD COPD Grading

Joan B. Soriano, MD; Inmaculada Alfageme, MD; Pere Almagro, MD; Ciro Casanova, MD; Cristobal Esteban, MD; Juan J. Soler-Cataluña, MD; Juan P. de Torres, MD; Pablo Martinez-Camblor, PhD; Marc Miravitlles, MD; Bartolome R. Celli, MD, FCCP; Jose M. Marin, MD
Author and Funding Information

From the Fundación Caubet-Cimera Centro Internacional de Medicina Respiratoria Avanzada (Dr Soriano), Bunyola, Spain; Área Hospitalaria de Valme (Dr Alfageme), Sevilla, Spain; Internal Medicine (Dr Almagro), Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Hospital Universitario Nuestra Señora de Candelaria (Dr Casanova), Tenerife, Spain; Hospital Galdakao-Usansolo (Dr Esteban), Galdakao, Bizkaia, Spain; Unidad de Neumología (Dr Soler-Cataluña), Servicio de Medicina Interna, Hospital General de Requena, Valencia, Spain; Clınica Universidad de Navarra (Dr de Torres), Pamplona, Spain; Oficina de Investigación Biosanitaria de Asturies and Oviedo University (Dr Martinez-Camblor), Oviedo, Spain; Hospital Clínic (Dr Miravitlles), Institut D’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Pulmonary and Critical Care Medicine (Dr Celli), Harvard University, Brigham and Women’s Hospital, Boston, MA; and Hospital Universitario Miguel Servet (Dr Marin), Zaragoza, Spain.

Correspondence to: Joan B. Soriano, MD, Program of Epidemiology and Clinical Research, CIMERA, Recinte Hospital Joan March, Carretera Soller Km 12. 07110-Bunyola, Illes Balears, Spain; e-mail: jbsoriano@caubet-cimera.es


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):694-702. doi:10.1378/chest.12-1053
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Background:  The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11 well-defined COPD cohorts and their prognostic validity up to 10 years to predict time to death.

Methods:  Spirometry in all 11 cohorts was postbronchodilator. Survival analysis and C statistics were used to compare the two GOLD systems by varying time points.

Results:  Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms), 515 (16.3%) were B (low risk, more symptoms), 561 (17.7%) were C (high risk, less symptoms), and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts (χ2, P < .01). No differences were seen in the C statistics of old vs new GOLD grading to predict mortality at 1 year (0.635 vs 0.639, P = .53), at 3 years (0.637 vs 0.645, P = .21), or at 10 years (0.639 vs 0.642, P = .76).

Conclusions:  The new GOLD grading produces an uneven split of the COPD population, one-third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.

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