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首页> 外文期刊>Journal of the American Medical Directors Association >Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease
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Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

机译：重新定义18,577例慢性阻塞性肺病患者慢性阻塞性肺病分类全球急性急性倡议的高症状负担

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摘要

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings A total of 18,577 patients with COPD [72.0% male; mean age: 66.3爕ears (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.
机译：摘要背景患者慢性阻塞性肺病（COPD）可以根据症状强度分为A / C或B / D组。症状问卷的不同阈值可能导致错误分类，反过来又会导致不同的治疗建议。主要目的是找到全球慢性阻塞性肺病（金）症状措施的最佳拟合切片，其改良的医学研究委员会呼吸困难2或更高的呼吸困难等级。方法在计算机化后，来自41个队列的数据以及其作者同意汇集提供数据的数据。 COPD研究有资格分析，如果它们包括，至少年龄，性别，近摄加速器肺活量测定法，改进的医学研究委员会和COPD评估试验（CAT）总分。主要成果接收器操作特征曲线和YENEN指数用于确定猫，COPD临床问卷和圣乔治呼吸问卷的最佳校准阈值。以下，基于当前切割点和新导出的切割点计算金A / B / C / D频率。调查结果总共18,577名患有COPD [72.0％的男性;平均年龄：66.3‰耳（标准偏差9.6）]进行了分析。大多数患者的气流限制（黄金肺血管级1,10.9％; 2级，46.6％; 3级，32.4％;和4.3％）。 CAT总成绩的最佳校准阈值为18分，对于COPD临床问卷总得分1.9分，为圣乔治呼吸问卷总得分46.0分。结论这些新切片的应用将重新分类约三分之一的COPD患者，从而会影响个体疾病管理。需要对这些新值的前瞻性研究进行进一步验证。

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  • 作者

    Dionne E. Smid; Frits M.E. Franssen; Maria Gonik; Marc Miravitlles; Ciro Casanova; Borja G. Cosio; Pilar de Lucas-Ramos; Jose M. Marin; Cristina Martinez; Isabel Mir; Joan B. Soriano; Juan P. de Torres; Alvar Agusti; Nart B. Atalay; Julia Billington; Afroditi K. Boutou; Stefanie Brighenti-Zogg; Emma Chaplin; Samantha Coster; James W. Dodd; Selina Dürr; Alberto Fernandez-Villar; Miriam T.J. Groenen; Miguel Guimar?es; Karel Hejduk; Victoria Higgins; Nicholas S. Hopkinson; Nobuyuki Horita; Sarah Houben-Wilke; Daisy J.A. Janssen; Melissa Jehn; Rudolf Joerres; Annika Karch; Julia L. Kelly; Yu-Il Kim; Hiroshi Kimura; Vladimir Koblizek; Janwillem H. Kocks; Samantha S.C. Kon; Namhee Kwon; Inês Ladeira; Sang-Do Lee; Joerg D. Leuppi; Nicholas Locantore; José L. Lopez-Campos; William D-C Man; Lana Maricic; Laura Mendoza; David Miedinger; Florin Mihaltan; Seigo Minami; Thys van der Molen; Trevor J. Murrells; Nienke Nakken; Yu Nishijima; Ian J. Norman; Barbora Novotna; Denis E. ODonnell; Yoshitaka Ogata; Eanes D. Pereira; James Piercy; David Price; Chaicharn Pothirat; Natya Raghavan; Thomas Ringbaek; Dimitar Sajkov; Naseh Sigari; Sally Singh; Mark Small; Guilherme F. da Silva; Rebecca J. Tanner; Ioanna G. Tsiligianni; Baykal Tulek; Nikolaos Tzanakis; Lowie E.G.W. Vanfleteren; Henrik Watz; Katherine A. Webb; Emiel F.M. Wouters; Guogang G. Xie; Masanori Yoshikawa; Martijn A. Spruit;

  • 作者单位

    Department of Research and Education CIRO;

    Department of Research and Education CIRO;

    Biomax Informatics AG Planegg;

    Pneumology Department Hospital Universitari Vall d'Hebron CIBER de Enfermedades Respiratorias;

    Pulmonary Department and Research Unit Hospital Universitario NS La Candelaria;

    Department of Respiratory Medicine Hospital Son Espases-IdISPa-CIBERES;

    Hospital General Universitario Gregorio Mara?on Pulmonary Department;

    Hospital Universitario Miguel Servet IISAragon CIBER Enfermedades Respiratorias;

    Pneumology Service Instituto Nacional de Silicosis-Hospital Universitario Central de Asturias;

    Hospital General Universitario Gregorio Mara?ón Madrid Pulmonary Department;

    Instituto de Investigación Hospital Universitario de la Princesa IISP Universidad Autónoma de;

    Pulmonary Department Clinica Universidad de Navarra;

    Respiratory Institute Hospital Clinic University of Barcelona and CIBERES;

    Department of Psychology TOBB University of Economics and Technology;

    Central Surgery Surbiton Health Centre Surbiton;

    Intensive Care Unit G Gennimats General Hospital;

    University Clinic of Medicine Cantonal Hospital Baselland;

    Center for Exercise and Rehabilitation Science NIHR Leicester Respiratory Biomedical Research Unit;

    King's College London Florence Nightingale Faculty of Nursing and Midwifery;

    Academic Respiratory Unit University of Bristol North Bristol Lung Centre Southmead Hospital;

    University Clinic of Medicine Cantonal Hospital Baselland;

    Servicio de Neumología Instituto de Investigación Biomédica de Vigo IBIV Complexo Hospitalario;

    Department of Research and Education CIRO;

    Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho;

    Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University;

    Adelphi Real World;

    NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust;

    Department of Pulmonology Yokohama City University Graduate School of Medicine;

    Department of Research and Education CIRO;

    Department of Research and Education CIRO;

    Arbeitsbereich Ambulante Pneumologie Charité Universit?tsmedizin Berlin;

    Institute and Output Clinic for Occupational and Environmental Medicine;

    Institute for Biostatistics Hannover Medical School;

    Academic Unit of Sleep and Ventilation National Heart and Lung Institute Imperial College London;

    Division of Pulmonology Department of Internal Medicine Chonnam National University Hospital;

    Second Department of Internal Medicine Nara Medical University;

    Department of Pneumology Faculty of Medicine in Hradec Kralove Charles University in Prague and;

    Department of Primary Care Groningen Research Institute for Asthma and COPD GRIAC University;

    The Hillingdon Hospital NHS Foundation Trust;

    Respiratory Franchise Medical GlaxoSmithKline (GSK);

    Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho;

    Department of Pulmonary and Critical Care Medicine Clinical Research Center for Chronic;

    University Clinic of Medicine Cantonal Hospital Baselland;

    GlaxoSmithKline;

    Unidad Médico-Quirúrgica de Enfermedades Respiratorias Instituto de Biomedicina de Sevilla IBiS;

    NIHR Respiratory Biomedical Research Unit Royal Brompton and Harefield NHS Foundation Trust and;

    University Hospital Osijek;

    Department of Internal Medicine;

    Faculty of Medicine University J.J;

    Hospital Clínico Universidad de Chile;

    University Clinic of Medicine Cantonal Hospital Baselland;

    Institute of Pneumology Marius Nasta;

    Department of Respiratory Medicine Osaka Police Hospital;

    Department of Primary Care Groningen Research Institute for Asthma and COPD GRIAC University;

    King's College London Florence Nightingale Faculty of Nursing and Midwifery;

    Department of Research and Education CIRO;

    Department of Respiratory Medicine Osaka Police Hospital;

    King's College London Florence Nightingale Faculty of Nursing and Midwifery;

    Department of Pneumology Faculty of Medicine in Hradec Kralove Charles University in Prague and;

    Department of Medicine Queen's University and Kingston General Hospital;

    Department of Respiratory Medicine Osaka Police Hospital;

    Federal University of Ceará-Brazil;

    Adelphi Real World;

    Observational and Pragmatic Research Institute;

    Division of Pulmonary Critical Care and Allergy Department of Internal Medicine Faculty of;

    Department of Medicine McMaster University;

    Department of Respiratory Medicine Hvidovre Hospital University of Copenhagen;

    Australian Respiratory and Sleep Medicine Institute Flinders Medical Center;

    Internal Medicine Department Medical Faculty Kurdistan University of Medical Sciences;

    Center for Exercise and Rehabilitation Science NIHR Leicester Respiratory Biomedical Research Unit;

    Adelphi Real World;

    University of Fortaleza/UNIFOR;

    NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust;

    Department of Primary Care Groningen Research Institute for Asthma and COPD GRIAC University;

    Department of Chest Diseases Faculty of Medicine Selcuk University;

    Department of Thoracic Medicine University Hospital of Heraklion Medical School University of;

    Department of Research and Education CIRO;

    Pulmonary Research Institute at Lung Clinic Grosshansdorf German Center for Lung Research;

    Department of Medicine Queen's University and Kingston General Hospital;

    Department of Research and Education CIRO;

    Department of Respiratory Medicine Shanghai General Hospital Shanghai Jiao Tong University School;

    Second Department of Internal Medicine Nara Medical University;

    Department of Research and Education CIRO;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;
  • 关键词

    COPD; GOLD; health status; clinical significance;

    机译：COPD;金;健康状况;临床意义;

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