title: Validation of the GOLD 2013 classification in predicting exacerbations and mortality in Taiwanese patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Evidence for the effectiveness of the new multidimensional GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification is currently limited. The new classification has been validated in the United States and Europe, but validation in Asian patients is still lacking. We examined the abilities of the GOLD 2013 classification to predict clinical outcomes in Taiwanese patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Patients with COPD were recruited from January 2006 to December 2012 and followed up for exacerbation and mortality. The predictive abilities of various assessments were compared through logistic regression analysis using receiver operating curve (ROC) estimations and area under the curve (AUC).
  
  
  RESULTS
  A total of 471 patients with COPD were analyzed. The GOLD 2013 groups at high risk of exacerbation (C and D) experienced a higher average number of exacerbations per year (2.1 ± 3.1 vs. 0.3 ± 1.0, p < 0.001) than the low risk groups (A and B). The mortality rates were 10.1% in GOLD 2013 Group A, 14.1% in Group B, 4.0% in Group C, and 30.5% in Group D. The AUC values for GOLD 2013 and GOLD 2007 were 0.78 versus 0.67 (p < 0.001) for exacerbation, and 0.66 versus 0.61 (p = 0.15) for mortality.
  
  
  CONCLUSIONS
  The GOLD 2013 classification has powerful ability to predict exacerbation, but poor ability to predict mortality. The prognostic validity of the GOLD 2013 classification to predict exacerbations was better than the GOLD 2007 classification.
authors: Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital Dou-liou Branch, Yunlin, Taiwan.
authors: Chiung-Zuei
authors: CZ
authors: Chen
authors: Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
authors: Chih-Ying
authors: CY
authors: Ou
authors: Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
authors: Chih-Hui
authors: CH
authors: Hsu
authors: Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan. Electronic address: hsiue@mail.ncku.edu.tw.
authors: Tzuen-Ren
authors: TR
authors: Hsiue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality*; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013624:Taiwan
keywords: chronic obstructive pulmonary disease; exacerbations; hospitalization; mortality; severity classification