PMID- 26712569 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20220316 IS - 1532-3064 (Electronic) IS - 0954-6111 (Print) IS - 0954-6111 (Linking) VI - 111 DP - 2016 Feb TI - Differences between absolute and predicted values of forced expiratory volumes to classify ventilatory impairment in chronic obstructive pulmonary disease. PG - 30-8 LID - S0954-6111(15)30085-8 [pii] LID - 10.1016/j.rmed.2015.11.004 [doi] AB - The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity criterion for COPD is used widely in clinical and research settings; however, it requires the use of ethnic- or population-specific reference equations. We propose two alternative severity criteria based on absolute post-bronchodilator FEV1 values (FEV1 and FEV1/height2) that do not depend on reference equations. We compared the accuracy of these classification schemasto those based on % predicted values (GOLD criterion) and Z-scores of post-bronchodilator FEV1 to predict COPD-related functional outcomes or percent emphysema by computerized tomography of the lung. We tested the predictive accuracy of all severity criteria for the 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), 36-item Short-Form Health Survey physical health component score (SF-36) and the MMRC Dyspnea Score. We used 10-fold cross-validation to estimate average prediction errors and Bonferroni-adjusted t-tests to compare average prediction errors across classification criteria. We analyzed data of 3772 participants with COPD (average age 63 years, 54% male). Severity criteria based on absolute post-bronchodilator FEV1 or FEV1/height2 yielded similar prediction errors for 6MWD, SGRQ, SF-36 physical health component score, and the MMRC Dyspnea Score when compared to the GOLD criterion (all p > 0.34); and, had similar predictive accuracy when compared with the Z-scores criterion, with the exception for 6MWD where post-bronchodilator FEV1 appeared to perform slightly better than Z-scores (p = 0.01). Subgroup analyses did not identify differences across severity criteria by race, sex, or age between absolute values and the GOLD criterion or one based on Z-scores. Severity criteria for COPD based on absolute values of post-bronchodilator FEV1 performed equally as well as did criteria based on predicted values when benchmarked against COPD-related functional and structural outcomes, are simple to use, and may provide a more accessible and comparable approach to severity classification worldwide, especially in settings where prediction equations are not available. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Checkley, William AU - Checkley W AD - Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. Electronic address: wcheckl1@jhmi.edu. FAU - Foreman, Marilyn G AU - Foreman MG AD - Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, USA. FAU - Bhatt, Surya P AU - Bhatt SP AD - Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA. FAU - Dransfield, Mark T AU - Dransfield MT AD - Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, USA. FAU - Han, MeiLan AU - Han M AD - Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, USA. FAU - Hanania, Nicola A AU - Hanania NA AD - Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, USA. FAU - Hansel, Nadia N AU - Hansel NN AD - Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA. FAU - Regan, Elizabeth A AU - Regan EA AD - Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, USA. FAU - Wise, Robert A AU - Wise RA AD - Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA. CN - COPDGene Study Investigators LA - eng GR - U01 HL089897/HL/NHLBI NIH HHS/United States GR - U01 HL089856/HL/NHLBI NIH HHS/United States GR - U01HL089897/HL/NHLBI NIH HHS/United States GR - K99 HL096955/HL/NHLBI NIH HHS/United States GR - R00HL096955/HL/NHLBI NIH HHS/United States GR - R00 HL096955/HL/NHLBI NIH HHS/United States GR - U01HL089856/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20151111 PL - England TA - Respir Med JT - Respiratory medicine JID - 8908438 SB - IM MH - Aged MH - Aged, 80 and over MH - Female MH - Forced Expiratory Volume MH - Humans MH - Male MH - Middle Aged MH - *Predictive Value of Tests MH - Pulmonary Disease, Chronic Obstructive/*diagnosis/diagnostic imaging/genetics/*physiopathology MH - Respiratory Insufficiency/genetics/*physiopathology MH - Severity of Illness Index MH - Spirometry/methods PMC - PMC4955626 MID - NIHMS746189 OTO - NOTNLM OT - COPD OT - Reference equations OT - Severity criteria COIS- Conflicts of interest The authors report no conflicts of interest. EDAT- 2015/12/30 06:00 MHDA- 2016/12/15 06:00 PMCR- 2017/02/01 CRDT- 2015/12/30 06:00 PHST- 2015/07/17 00:00 [received] PHST- 2015/10/26 00:00 [revised] PHST- 2015/11/05 00:00 [accepted] PHST- 2015/12/30 06:00 [entrez] PHST- 2015/12/30 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] PHST- 2017/02/01 00:00 [pmc-release] AID - S0954-6111(15)30085-8 [pii] AID - 10.1016/j.rmed.2015.11.004 [doi] PST - ppublish SO - Respir Med. 2016 Feb;111:30-8. doi: 10.1016/j.rmed.2015.11.004. Epub 2015 Nov 11.