Mortality Predictions in COPD

January 21, 2016
Dava Stewart

French researchers explored whether or not the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors. They found patients assessed as having low risk but who had more symptoms were more likely than other patients to die of cardiovascular causes.

Researchers explored whether or not the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors. They found that more patients in GOLD Group B die due to adjudicated cardiovascular causes than in other groups, while more deaths occur due to respiratory causes in Groups C and D. The study was led by Daniel Dusser, MD, of the Hospital Cochin in Paris, France, and was published in the International Journal of COPD on January 20, 2016.

The GOLD guidelines were changed to an A-D system in 2011, and were last updated in early 2015. “This system distinguishes between four categories of patients with COPD based on the assessment of symptoms, severity of airflow limitation using spirometry, and exacerbation risk: A = low risk, fewer symptoms; B = low risk, more symptoms; C = high risk, fewer symptoms; and D = high risk, more symptoms,” according to the introduction of this study.

In order to complete this study, the researchers used “data from the TIOSPIR study, the largest randomized clinical trial in COPD performed to date.” The TIOSPIR study included 16,326 patients. The goal of the current study was to “investigate the ability of different GOLD groups to predict important clinical outcomes in COPD.” They expected “there would be differences in the risk of death, the causes of death, and hospitalizations between groups.”

One of the results of the analysis was finding that “all-cause mortality did not increase consistently from GOLD Groups A-D. There were proportionally more deaths from any cause in Group B than in Groups A and C, although Group D had the highest death rate in total.” However, the risk of death from respiratory causes did increase consistently from Group A to Group D.

The researchers concluded that “Group B patients, with more symptoms and better lung function, have more underlying cardiovascular (CV) comorbidities as well as an increased CV mortality compared to Groups A and C.” They suggest that “particular attention should be given to patients” with high modified Medical Research Council dyspnea scores “who may be at increased risk of CV events and mortality.”