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Prognostic Accuracy of Three COPD Classification Systems in Relation to Long-Term Mortality of COPD Patients: A Prospective Multicenter Study

  • Marek Plutinsky
  • Kristian BratEmail author
  • Michal Svoboda
  • Jaromir Zatloukal
  • Patrice Popelkova
  • Vladimir Koblizek


Recent research showed group B patients express higher mortality compared to group C patients when GOLD A-D grouping is used. We aimed to compare the prognostic accuracy of three GOLD classification systems, I–IV (“pre-2011”), A-D (“2011–2016”) and A-D (“2017–present”) in relation to mortality, exacerbation risk, quality of life (QoL) assessment and specific treatments use in a real-life COPD cohort. We used the data of 720 patients from the Czech Multicenter Research Database of COPD. Four-year mortality and time-to-exacerbation using the GOLD “pre-2011”, “2011–2016” and “2017–present” classification schemes were assessed. Moreover, distribution of specific treatments use and QoL measures were analyzed. The GOLD I-IV classification system showed gradual increase in 4-year mortality across the stages (GOLD II 18.8%, III 28.5%, IV 38.7%) (p = 0.001). Using the A-D “2011–2016” classification scheme, group C patients had lower mortality (16.7%) than group B (18.7%) (p = 0.009). The A-D “2017–present” classification showed higher mortality in group B (25.5%) compared to group C (20%) (p = 0.05). For additional outcomes, the GOLD I–IV scheme showed highest match between the calculated 4-year exacerbation risk and QoL measures and GOLD stage/grouping. In terms of specific treatment distributions, various patterns for each GOLD classification system were observed with best match of GOLD “2017–present” system to the layout of GOLD groups and categories. We conclude the GOLD I–IV classification system had the highest accuracy related to mortality, QoL measures and exacerbation risk prediction, while the A-D “2017–present” scheme was most accurate within severity of symptoms prediction reflected also by more frequent specific treatments use.


COPD GOLD classification Prognosis Mortality 



We thank the physicians of participating centers of the CMRD project.


This research was funded by Ministry of Health of the Czech Republic (15/14/NAP; 5/15/NAP; UHHK 00179906 and FNBr 65269705) and by a consortium of pharmaceutical companies (Angelini CZ, AstraZeneca CZ, Boehringer Ingelheim CZ, Cipla CZ, CSL Behring CZ, GSK CZ, Novartis CZ and Sandoz CZ).

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest in relation to the presented work.

Supplementary material

408_2019_196_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 KB)


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Respiratory DiseasesUniversity Hospital Brno and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
  2. 2.Institute of Biostatistics and Analyses, Ltd.BrnoCzech Republic
  3. 3.Pulmonary DepartmentUniversity Hospital Olomouc and Faculty of Medicine, Palacky UniversityOlomoucCzech Republic
  4. 4.Pulmonary DepartmentUniversity Hospital OstravaOstravaCzech Republic
  5. 5.Pulmonary DepartmentUniversity Hospital Hradec Kralove and Charles UniversityHradec KraloveCzech Republic

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