title: Prognostic utility of the 2011 GOLD classification and other multidimensional tools in Asian COPD patients: a prospective cohort study.
abstract: BACKGROUND
  How well the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification prognosticates for Asian patients with COPD is unknown.
  
  
  OBJECTIVE
  The authors aimed to study the predictive utility of the GOLD 2011 classification for exacerbations and mortality as compared with other multidimensional tools in an Asian population.
  
  
  METHODS
  In all, 1,110 COPD patients were prospectively followed between March 2008 and March 2013. They were classified using the 2011 and 2007 GOLD guidelines, modified Medical Research Council score, St. George's Respiratory Questionnaire (SGRQ), and Body mass index, Obstruction, Dyspnea (BOD) index. Outcome measures were exacerbations and mortality. Multivariable survival analyses and receiver operating characteristic (ROC) curves were used to assess the different classification systems.
  
  
  RESULTS
  Time-to-event analyses demonstrated earlier exacerbations in 2011's GOLD D when compared with GOLD A (hazard ratio [HR] 0.54, 95% confidence interval [CI]: 0.31-0.95, P=0.032) and GOLD B (HR 0.62, 95% CI: 0.45-0.85, P=0.003) and higher mortality when compared with GOLD A (HR 0.37, 95% CI: 0.16-0.88, P=0.025) and GOLD B (HR 0.46, 95% CI: 0.31-0.70, P<0.001). The areas under the ROC curve for GOLD 2011, GOLD 2007, modified Medical Research Council, St. George's Respiratory Questionnaire, and BOD index were 0.62, 0.59, 0.61, 0.60, and 0.61, respectively, for the prediction of exacerbations and 0.71, 0.70, 0.71, 0.71, and 0.72, respectively, for the prediction of mortality (ROC comparator, P>0.05).
  
  
  CONCLUSIONS
  The 2011 GOLD classification predicts exacerbations and mortality moderately well in Asian COPD patients. Its prognostic utility is similar to that of other multidimensional systems.
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Hiang Ping
authors.initials: HP
authors.lastname: Chan
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Pauline Lee Poh
authors.initials: PL
authors.lastname: Chong
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Sally
authors.initials: S
authors.lastname: Chin
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Xue Yun
authors.initials: XY
authors.lastname: Wong
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Venetia
authors.initials: V
authors.lastname: Ong
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Tow Keang
authors.initials: TK
authors.lastname: Lim
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, National University of Singapore, Singapore.
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
mesh_terms: D000368:Aged; D044466:Asian People; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality*
keywords: COPD; guideline; morbidity; mortality; prognosis