Letter to the Director
A Novel Figure and Algorithm for the GOLD-ABE Classification: Additional Comments
Rafael Golpea,
, Juan Marco Figueira-Gonçalvesb,c, Cristóbal Esteband,e, Carlos A. Amadof,g, David Dacal-Rivasa, Iria Veigaa
Corresponding author
a Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
b Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
c University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain
d Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, Spain
e Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Bizkaia, Spain
f Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
g Universidad de Cantabria, Instituto de Investigación Sanitaria de Cantabria IDIVAL, Spain
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Amado, David Dacal-Rivas, Iria Veiga" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Rafael" "apellidos" => "Golpe" "email" => array:2 [ 0 => "rafagolpe@gmail.com" 1 => "rafael.golpe.gomez@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan Marco" "apellidos" => "Figueira-Gonçalves" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Cristóbal" "apellidos" => "Esteban" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "Carlos A." "apellidos" => "Amado" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 4 => array:3 [ "nombre" => "David" "apellidos" => "Dacal-Rivas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Iria" "apellidos" => "Veiga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Bizkaia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Universidad de Cantabria, Instituto de Investigación Sanitaria de Cantabria IDIVAL, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Miravitlles et al. propose in their recent editorial a new figure and algorithm for the GOLD-ABE assessment tool.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> They rightly point out that the ABE classification is actually made up of four groups, because patients in group E with blood eosinophilia should be started early on triple therapy (LABA/LAMA/ICS). One of the authors also proposed another modification of the ABE classification that adds a third dimension to said classification.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The authors’ proposal characterizes B and E patients as B+ and E+ if they have cardiovascular disease (CVD) or increased cardiovascular risk (CVR). They suggest that this scheme could serve as a basis for earlier treatment of some patients with triple therapy and mention two potential benefits: a reduction in the decline of lung function, and a possible benefit in mortality, which could be partially mediated by a reduction in cardiovascular events. In fact, both benefits could be related, since there may be an association between lung function and CVD.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Adoption of this modified scheme to guide therapy should be preceded by appropriate studies, and a first step should be to assess whether this modified classification improves prediction of future risk compared to the current GOLD scheme.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Neither the current GOLD-ABE nor the latest GOLD-ABCD classifications (2017 and later) used lung function to decide initial drug treatment, unlike previous GOLD-2011 recommendations or current GesEPOC algorithms.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In a previous study, we found that a three-dimensional modification of the GOLD-2017-ABCD scheme, similar to that proposed by Kostikas et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> but using lung function instead of CVD/CVR, increased its ability to predict future risk.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> We performed a post hoc analysis of the data from said study with the objectives of (A) verifying whether the classifications proposed by Kostikas et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> (GOLD-ABE-3D) and Miravitlles et al. (GOLD-ABE-Eos)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> increase the capacity of predicting future mortality risk over current GOLD-ABE classification and (B) determine how another three-dimensional modification of GOLD-ABE, using lung function to establish the third dimension of the scheme (GOLD-ABE-function), compares with the other classifications.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patients were classified according to the four schemes. For GOLD-ABE-3D, patients from the B and E groups were classified as B+ and E+ if any of the following diseases had been diagnosed on the index date: chronic heart failure, ischaemic heart disease, peripheral vascular disease, cerebrovascular disease or atrial fibrillation. For GOLD-ABE-Eos, patients from the E group were classified as E-1 (non-eosinophilic) or E-2 (eosinophilic), following the methodology of a previous study.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> For GOLD-ABE-function, patients from the A, B and E groups were classified into subgroups -1 or -2 according to whether their FEV<span class="elsevierStyleInf">1</span>% was ≥50% (−1) or <50% (−2). The outcome variable was all-cause mortality. The ability of the classifications to predict outcome was compared using receiver-operating characteristics curves. The areas under the curves (AUCs) were compared according to DeLong et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 954 patients were studied, of whom 169 died after a mean follow-up of 51.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.2 months. Eosinophils counts were not available for all participants, so only 920 patients could be classified according to GOLD-ABE-Eos. The AUCs were: GOLD-ABE: 0.676 (95% CI: 0.645–0.705); GOLD-ABE-Eos: 0.657 (95% CI: 0.625–0.687), GOLD-ABE-3D: 0.689 (95% CI: 0.659–0.718); GOLD-ABE-function: 0.695 (95% CI: 0.664–0.724). AUCs for GOLD-ABE-3D and GOLD-ABE-function were significantly higher than for GOLD-ABE (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02, respectively). There were no significant differences between GOLD-ABE-3D and GOLD-ABE-function (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.54), nor between GOLD-ABE-Eos and GOLD-ABE (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.83).</p><p id="par0025" class="elsevierStylePara elsevierViewall">These results indicate that the proposed GOLD-ABE classification<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> can be refined to better predict mortality risk, including either CVD/CVR or lung function. This is a relevant finding to design future studies that evaluate early triple therapy, with the aim of improving survival. A three-dimensional classification that uses lung function instead of CVD increases the prediction of mortality similarly to that of Kostikas et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> A possible link between lung function and CVR might explain this finding. The diagnosis of CVD is challenging in COPD patients, since the symptoms of both diseases overlap, whereas lung function measurement is a simple and indispensable evaluation in COPD. Therefore, modifying the ABE algorithm proposed by Miravitlles et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> by adding lung function could be considered when designing future clinical trials on early implementation of triple therapy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel figure and algorithm for the Gold ABE classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 54 | 29 | 83 |
| 2024 September | 72 | 14 | 86 |
| 2024 August | 82 | 46 | 128 |
| 2024 July | 71 | 27 | 98 |
| 2024 June | 72 | 22 | 94 |
| 2024 May | 79 | 24 | 103 |
| 2024 April | 64 | 19 | 83 |
| 2024 March | 57 | 19 | 76 |
| 2024 February | 55 | 32 | 87 |
| 2024 January | 99 | 35 | 134 |
| 2023 December | 410 | 81 | 491 |
| 2023 November | 94 | 42 | 136 |
| 2023 October | 370 | 137 | 507 |
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