Beyond gold: A comparison of the 2007 and 2011 COPD GOLD classifications as predictors of all-cause mortality, morbidity, hospitalizations for COPD exacerbations and pneumonias in patients with COPD within the COMIC study.

Klatte, M. (Maurits) (2014) Beyond gold: A comparison of the 2007 and 2011 COPD GOLD classifications as predictors of all-cause mortality, morbidity, hospitalizations for COPD exacerbations and pneumonias in patients with COPD within the COMIC study. thesis, Medicine.

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Abstract

Background and aims: In 2001, the Global Initiative for Chronic Obstructed Pulmonary Disease (GOLD) presented a stratification in which patients with chronic obstructed pulmonary disease (COPD) are identified based spirometric lung function. This stratification is revised in 2007, however it was still based on spirometry. Today a more multidisciplinary approach is used because spirometry has limitations as lung function correlates poorly with clinically relevant outcomes such as health-related quality of life, breathlessness, and exercise capacity. Therefore, GOLD updated their model again in 2011 and added risk and burden of disease to the 2007 model. The risk is based on COPD exacerbations and COPD hospitalizations in the past year, the burden of COPD is measured with questionnaires. Main objective of our study is to investigate if the 2011 COPD GOLD model is a better predictor of mortality and morbidity then the former /old 2007 COPD GOLD model. A second question is if the use of different questionnaires changes the outcomes in the new COPD classifications. Methods: We conducted a prospective cohort study of 645 clinical COPD patients in the COMIC study. All data needed to assess patients in the 2007 and 2011 GOLD models was known. A comparison was made beween these models in their ability to predict all cause mortality, hospitalizations and the development of pneumonias. C-statistics and their ability to discriminate between the four categories were used in determining if there was a difference between the models. The 2011 model was tested with the mMRC and the CCQ questionnaire. In the CCQ a cut off point of 1.0 and 1.5 was used. Results: Overall, C-statistics was higher in the 2011 models (0.65-0.75) in comparison to the 2007 model (0.65) in predicting all cause mortality. When the 2011 GOLD mMRC (C-statistic 0.65) model was compared to the 2011 CCQ models, higher C- statistics are seen when the CCQ- questionnaire is used . (0.74-0.75). Next, the CCQ with the cut off of 1.5 showed to discriminate better then the CCQ with cut off of 1.0. The same results were seen in the analyses of hospitalizations and pneumonias. Conclusion: The 2011 COPD GOLD stratification predicted mortality and morbidity better then the 2007 COPD GOLD model when C- statistics and discrimination between the four categories are compared. In the 2011 GOLD model, the CCQ with cut off of 1.5 performs best.

Item Type:	Thesis (Thesis)
Supervisor name:	Valk, Dr. P. van der and Telgen-Zuur, M. and Brusse-Keizer, M.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:59
Last Modified:	25 Jun 2020 10:59
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1967

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