Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study
Abstract The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, based on percent predicted forced expiratory volume in 1 s (ppFEV1), has been widely adopted for assessment of chronic obstructive pulmonary disease (COPD) severity. However, the STaging of Airflow obstruction...
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Nature Portfolio
2025-05-01
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| Online Access: | https://doi.org/10.1038/s41598-025-05033-w |
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| author | Hiroaki Ogata Kazuya Tsubouchi Tomotsugu Takano Katsuyuki Ichiki Ryo Torii Shohei Takata Noriaki Nakagaki Makoto Yoshida Yasuhiko Kitasato Kazunori Tobino Eiji Harada Hiroshi Wataya Hiroshi Ishii Takashige Maeyama Masayuki Kawasaki Masaki Fujita Kazuhiro Yatera Yoshiaki Zaizen Yoichi Nakanishi Isamu Okamoto |
| author_facet | Hiroaki Ogata Kazuya Tsubouchi Tomotsugu Takano Katsuyuki Ichiki Ryo Torii Shohei Takata Noriaki Nakagaki Makoto Yoshida Yasuhiko Kitasato Kazunori Tobino Eiji Harada Hiroshi Wataya Hiroshi Ishii Takashige Maeyama Masayuki Kawasaki Masaki Fujita Kazuhiro Yatera Yoshiaki Zaizen Yoichi Nakanishi Isamu Okamoto |
| author_sort | Hiroaki Ogata |
| collection | DOAJ |
| description | Abstract The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, based on percent predicted forced expiratory volume in 1 s (ppFEV1), has been widely adopted for assessment of chronic obstructive pulmonary disease (COPD) severity. However, the STaging of Airflow obstruction by Ratio (STAR) system, based on the ratio of FEV1 to forced vital capacity, was recently proposed as an alternative classification. This study aimed to compare the prognostic performance of the GOLD and STAR classifications for prediction of mortality and exacerbation risk in individuals with COPD. This 5-year prospective, multicenter cohort study enrolled 370 individuals with COPD at 29 medical centers. All-cause mortality risk across GOLD and STAR stages was evaluated with Kaplan-Meier curves and Cox proportional hazards models. The risk of moderate to severe COPD exacerbations across GOLD and STAR stages was examined with cumulative incidence function (CIF) curves and Fine and Gray models. Both classification systems showed a significant association with mortality and exacerbation risk (P < 0.01 for trend). The GOLD classification provided a better separation of Kaplan-Meier and CIF curves for advanced stages, whereas the STAR classification showed a clearer distinction between stages I and II. These associations remained consistent after multivariable adjustments. The GOLD classification was superior for prediction of prognosis in advanced COPD, whereas the STAR classification provided better differentiation in early-stage disease. These findings highlight the complementary roles of the GOLD and STAR classifications in assessment of COPD severity. |
| format | Article |
| id | doaj-art-44986bae02ee496b9e55e0185d70b7d3 |
| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-44986bae02ee496b9e55e0185d70b7d32025-08-20T02:00:07ZengNature PortfolioScientific Reports2045-23222025-05-0115111110.1038/s41598-025-05033-wMortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort studyHiroaki Ogata0Kazuya Tsubouchi1Tomotsugu Takano2Katsuyuki Ichiki3Ryo Torii4Shohei Takata5Noriaki Nakagaki6Makoto Yoshida7Yasuhiko Kitasato8Kazunori Tobino9Eiji Harada10Hiroshi Wataya11Hiroshi Ishii12Takashige Maeyama13Masayuki Kawasaki14Masaki Fujita15Kazuhiro Yatera16Yoshiaki Zaizen17Yoichi Nakanishi18Isamu Okamoto19Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu UniversityKirigaoka Tsuda HospitalDepartment of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental HealthDepartment of Respiratory Medicine, NHO Fukuokahigashi Medical CenterDepartment of Respiratory Medicine, Japanese Red Cross Fukuoka HospitalDepartment of Respiratory Medicine, NHO Fukuoka National HospitalDepartment of Respiratory Medicine, Japan Community Health Care Organization Kurume General HospitalDivision of Respiratory Medicine, Aso Iizuka HospitalDepartment of Respiratory Medicine, Kitakyushu Municipal Medical CenterDepartment of Respiratory Medicine, Harasanshin HospitalDepartment of Respiratory Medicine, Fukuoka University Chikushi HospitalDepartment of Respiratory Medicine, Hamanomachi HospitalDepartment of Respiratory Medicine, NHO Omuta National HospitalDepartment of Respiratory Medicine, Fukuoka University School of MedicineDepartment of Respiratory Medicine, University of Occupational and Environmental HealthDivision of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of MedicineKitakyushu City Hospital OrganizationDepartment of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu UniversityAbstract The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, based on percent predicted forced expiratory volume in 1 s (ppFEV1), has been widely adopted for assessment of chronic obstructive pulmonary disease (COPD) severity. However, the STaging of Airflow obstruction by Ratio (STAR) system, based on the ratio of FEV1 to forced vital capacity, was recently proposed as an alternative classification. This study aimed to compare the prognostic performance of the GOLD and STAR classifications for prediction of mortality and exacerbation risk in individuals with COPD. This 5-year prospective, multicenter cohort study enrolled 370 individuals with COPD at 29 medical centers. All-cause mortality risk across GOLD and STAR stages was evaluated with Kaplan-Meier curves and Cox proportional hazards models. The risk of moderate to severe COPD exacerbations across GOLD and STAR stages was examined with cumulative incidence function (CIF) curves and Fine and Gray models. Both classification systems showed a significant association with mortality and exacerbation risk (P < 0.01 for trend). The GOLD classification provided a better separation of Kaplan-Meier and CIF curves for advanced stages, whereas the STAR classification showed a clearer distinction between stages I and II. These associations remained consistent after multivariable adjustments. The GOLD classification was superior for prediction of prognosis in advanced COPD, whereas the STAR classification provided better differentiation in early-stage disease. These findings highlight the complementary roles of the GOLD and STAR classifications in assessment of COPD severity.https://doi.org/10.1038/s41598-025-05033-wChronic obstructive pulmonary diseaseForced expiratory volumePrognosis |
| spellingShingle | Hiroaki Ogata Kazuya Tsubouchi Tomotsugu Takano Katsuyuki Ichiki Ryo Torii Shohei Takata Noriaki Nakagaki Makoto Yoshida Yasuhiko Kitasato Kazunori Tobino Eiji Harada Hiroshi Wataya Hiroshi Ishii Takashige Maeyama Masayuki Kawasaki Masaki Fujita Kazuhiro Yatera Yoshiaki Zaizen Yoichi Nakanishi Isamu Okamoto Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study Scientific Reports Chronic obstructive pulmonary disease Forced expiratory volume Prognosis |
| title | Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study |
| title_full | Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study |
| title_fullStr | Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study |
| title_full_unstemmed | Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study |
| title_short | Mortality and exacerbation risk according to GOLD and STAR severity stages of COPD: a 5-year multicenter prospective cohort study |
| title_sort | mortality and exacerbation risk according to gold and star severity stages of copd a 5 year multicenter prospective cohort study |
| topic | Chronic obstructive pulmonary disease Forced expiratory volume Prognosis |
| url | https://doi.org/10.1038/s41598-025-05033-w |
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