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00925njm 22002777a 4500 dc Smid, Dionne E author Franssen, Frits M. E author Gonik, Maria author Miravitlles, Marc author Casanova, Ciro author García-Cosío, Borja author de Lucas, Pilar author Marin, Jose M author Martinez, Cristina author Mir, Isabel author Soriano, Joan B author De Torres Tajes, Juan Pablo author Agusti, Alvar author Atalay, Nart B author Billington, Julia author Boutou, Afroditi K author Brighenti-Zogg, Stefanie author Chaplin, Emma author Coster, Samantha author Dodd, James W author Durr, Selina author Fernandez-Villar, Alberto author Groenen, Miriam T. J author Guimaraes, Miguel author Hejduk, Karel author Higgins, Victoria author Hopkinson, Nicholas S author Horita, Nobuyuki author Houben-Wilke, Sarah author Janssen, Daisy J. A author Jehn, Melissa author Joerres, Rudolf author Karch, Annika author Kelly, Julia L author Kim, Yu-Il author Kimura, Hiroshi author Koblizek, Vladimir author Kocks, Janwillem H author Kon, Samantha S. C author Kwon, Namhee author Ladeira, Ines author Lee, Sang-Do author Leuppi, Joerg D author Locantore, Nicholas author Lopez-Campos, Jose Luis author Man, William D-C author Maricic, Lana author Mendoza, Laura author Miedinger, David author Mihaltan, Florin author Minami, Seigo author van der Molen, Thys author Murrells, Trevor J author Nakken, Nienke author Nishijima, Yu author Norman, Ian J author Novotna, Barbora author O'Donnell, Denis E author Ogata, Yoshitaka author Pereira, Eanes D author Piercy, James author Price, David author Pothirat, Chaicharn author Raghavan, Natya author Ringbaek, Thomas author Sajkov, Dimitar author Sigari, Naseh author Singh, Sally author Small, Mark author da Silva, Guilherme F author Tanner, Rebecca J author Tsiligianni, Ioanna G author Tulek, Baykal author Tzanakis, Nikolaos author Vanfleteren, Lowie E. G. W author Watz, Henrik author Webb, Katherine A author Wouters, Emiel F. M author Xie, Guogang G author Yoshikawa, Masanori author Spruit, Martijn A author 2017-12-01 Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. Smid Dionne E., Franssen Frits M. E., Gonik Maria, Miravitlles Marc, Casanova Ciro, Cosio Borja G, et al. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc. 2017 Dec 01;18(12):1097.e11-1097.e24. 10.1016/j.jamda.2017.09.003 1538-9375 1525-8610 Journal of the American Medical Directors Association http://hdl.handle.net/20.500.13003/9538 29169740 L619348842 2-s2.0-85034568244 http://hdl.handle.net/20.500.12105/20495 416478400025 COPD GOLD health status clinical significance Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease