接受肺康复治疗的慢性阻塞性肺病患者的 GOLD 和 STAR 严重程度分级比较。

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2024-10-18 DOI:10.1016/j.chest.2024.10.013

Pasquale Ambrosino,Michele Vitacca,Giuseppina Marcuccio,Antonio Spanevello,Nicolino Ambrosino,Mauro Maniscalco

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引用次数: 0

摘要

背景除了公认的全球阻塞性肺病倡议（GOLD）分类外，还提出了按比例对气流阻塞（STAR）严重程度进行分级的方案，用于对慢性阻塞性肺病（COPD）进行分类。研究问题在进入康复环境的重度 COPD 患者中，GOLD 和 STAR 分类的一致性和实用性如何？研究设计和方法在这项多中心回顾性研究中回顾了医疗记录，检查了一大批接受肺康复（PR）治疗的 COPD 患者的主要功能变量及其变化。与 GOLD 相比，使用 STAR 分级法可使 53.4% 的患者获得不同的疾病严重程度类别。非加权科恩κ值为0.25，Bangdiwala B值为0.24，显示两种分类方法的一致性尚可。较高的加权一致度（分别为 0.47 和 0.78）表明，分类之间的差异主要发生在连续的分期上。GOLD 对慢性呼吸衰竭的分期显示出更高的区分度，而 STAR 在检测过度充气方面表现出更好的性能。在 PR 环境中的应用方面，GOLD 与 STAR 相比，在识别 6 分钟步行距离和改良医学研究委员会（mMRC）评分的最小临床重要性差异（MCID）方面表现更佳。因此，GOLD 而非 STAR 是实现 mMRC MCID 的独立预测因子（OR：1.48；95% CI：1.12-1.94；P=0.005），而且还能独立预测 Braden 评分的变化（β=0.154；P=0.004）。

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A Comparison of GOLD and STAR Severity Stages in Individuals with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation.

BACKGROUND Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD). STUDY QUESTION What is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting? STUDY DESIGN AND METHODS Medical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR). RESULTS A total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004). INTERPRETATION STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.