Impact of the Race-Neutral Equation on Mortality Risk Prediction in Korean Patients With Chronic Obstructive Pulmonary Disease.

IF 6.6 2区 医学 Q1 RESPIRATORY SYSTEM
Respirology Pub Date : 2025-07-03 DOI:10.1111/resp.70052
Kwonhyung Hyung, Hyun Woo Lee, Joon Young Choi, Deog Kyeom Kim, Yong Il Hwang, Ki-Eun Hwang, Hyun Jung Kim, Ji-Yong Moon, Kwang Ha Yoo, Chang-Hoon Lee
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Abstract

Background and objective: Recently, GLI-2022, a race-neutral reference equation, was proposed for spirometric interpretation. However, the impact of using the GLI-2022 in predicting mortality risk has not been fully investigated. This study determined whether the GOLD grades based on GLI-2022 or race-specific equations are overestimated or underestimated in terms of mortality risk prediction among Korean patients with COPD.

Methods: The participants were enrolled in a prospective COPD cohort study conducted between 2005 and 2022. Patients were classified into GOLD 1 to GOLD 4 based on the post-bronchodilator forced expiratory volume in 1 s (FEV1) % predicted using the GLI-2022, GLI Northeast Asian (GLI-2012), Choi's, and KNHANES-VI reference equations. The risk of all-cause mortality was compared between GOLD grades calculated using different equations.

Results: Among 1989 patients with COPD, 336 died during a median follow-up of 5.0 years (interquartile range, 3.1-7.3). The GLI-2022 estimated FEV1% predicted lower than those of GLI-2012, Choi's, and KNHANES-VI. No differences were found in the discrimination or calibration between the mortality prediction models. Rather, the GLI-2022 equation discriminated the mortality risk between the GOLD 1 and GOLD 2 groups (adjusted hazard ratio [aHR], 1.46; 95% confidence interval [CI], 1.05-2.03); however, the race-specific equations did not (Choi's: aHR, 1.22; 95% CI, 0.80-1.85; KNHANES-VI: aHR, 1.19; 95% CI, 0.77-1.82).

Conclusion: Our results suggest that race-specific equations may overestimate the severity of airflow obstruction in Korean patients with mild COPD, which supports the new recommendation for the use of the GLI-2022.

种族中性方程对韩国慢性阻塞性肺疾病患者死亡风险预测的影响
背景与目的:最近,一个种族中立的参考方程gli2022被提出用于肺活量测定的解释。然而,使用GLI-2022预测死亡风险的影响尚未得到充分调查。本研究确定了基于GLI-2022或种族特异性方程的GOLD分级在韩国COPD患者死亡风险预测方面是否被高估或低估。方法:参与者参加了2005年至2022年间进行的一项前瞻性COPD队列研究。根据使用glii -2022、GLI东北亚(glii -2012)、Choi’s和KNHANES-VI参考方程预测的支气管扩张剂后1秒用力呼气量(FEV1) %,将患者分为GOLD 1至GOLD 4。用不同的公式计算GOLD分级,比较全因死亡率的风险。结果:1989例COPD患者中,336例在中位随访5.0年期间死亡(四分位数范围为3.1-7.3)。glii -2022预测的FEV1%低于glii -2012、Choi’s和KNHANES-VI。两种死亡率预测模型在判别和校正方面均无差异。相反,GLI-2022方程区分了GOLD 1组和GOLD 2组之间的死亡风险(调整风险比[aHR], 1.46;95%置信区间[CI], 1.05-2.03);然而,种族特异性方程没有(Choi的:aHR, 1.22;95% ci, 0.80-1.85;KNHANES-VI: aHR, 1.19;95% ci, 0.77-1.82)。结论:我们的研究结果表明,种族特异性方程可能高估了韩国轻度COPD患者气流阻塞的严重程度,这支持了使用gil -2022的新建议。
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来源期刊
Respirology
Respirology 医学-呼吸系统
CiteScore
10.60
自引率
5.80%
发文量
225
审稿时长
1 months
期刊介绍: Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and clinically-relevant experimental respiratory biology and disease. Fields of research include immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology, physiology, paediatric respiratory medicine, clinical trials, interventional pulmonology and thoracic surgery. The Journal aims to encourage the international exchange of results and publishes papers in the following categories: Original Articles, Editorials, Reviews, and Correspondences. Respirology is the preferred journal of the Thoracic Society of Australia and New Zealand, has been adopted as the preferred English journal of the Japanese Respiratory Society and the Taiwan Society of Pulmonary and Critical Care Medicine and is an official journal of the World Association for Bronchology and Interventional Pulmonology.
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