Introduction

Recently, the Global Initiative for Obstructive Lung Disease (GOLD) has released an update on the Global Strategy for Prevention, Diagnosis and Management of COPD (the 2023 GOLD Report). A new classification of COPD was introduced, limiting the case classification to three groups (A, B and E), based on symptoms degree and exacerbation history.

Aim

Our aim was to assess prognostic properties of the current and previous GOLD classifications and compare them with the BODE index.

Methods

We used the data of 784 patients of the Czech Multicenter Research Database of COPD (CMRD). Survival analysis was performed using the Kaplan-Meier (KM) estimate and Cox model of proportional risks methods. Survival probability estimates, median survival and hazard ratios (HR) were supplemented with 95% confidence intervals (CI). ROC analysis and area under curve (AUC) were used for comparison of GOLD classifications and BODE index.

Results

Head-to-head comparison of the GOLD classifications showed superiority of the BODE index (AUC 0.715; p<0.001) over the GOLD classifications in terms of mortality risk prediction. The prognostic value of all tested GOLD classification systems was similar with AUCs (95%CI) 0.576 (0.543-0.609) for GOLD 2011 A-D, 0.557 (0.521 to 0.592) for GOLD 2017 A-D and 0.557 (0.521 to 0.592) for GOLD 2023 A-E.

Conclusion

The prognostic value of the GOLD 2023 classification (groups A-B-E) remains comparably poor to previous classification schemes. The GOLD grouping is not suitable for assessment of patient prognosis. Instead, multidimensional prognostic tools (e.g. the BODE index) should be used to estimate mortality risk in patients with COPD.