title: Distribution and prognostic validity of the new Global Initiative for Chronic Obstructive Lung Disease grading classification.
abstract: 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 ( x (2) , 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.
authors.affiliation: Fundación Caubet-Cimera Centro Internacional de Medicina Respiratoria Avanzada, Bunyola, Spain. Electronic address: jbsoriano@caubet-cimera.es.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: Área Hospitalaria de Valme, Sevilla, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alfageme
authors.affiliation: Internal Medicine, Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Almagro
authors.affiliation: Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.affiliation: Clınica Universidad de Navarra, Pamplona, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: de Torres
authors.affiliation: Oficina de Investigación Biosanitaria de Asturies and Oviedo University, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Camblor
authors.affiliation: Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Pulmonary and Critical Care Medicine, Harvard University, Brigham and Women's Hospital, Boston, MA.
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Marin
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D013147:Spirometry