Race-neutral equation a better predictor of mortality risk in COPD patients: study

Race-specific equations tend to overestimate the severity of airflow obstruction in patients with mild chronic obstructive pulmonary disease (COPD), suggests a Korea study.

“Recently, GLI-2022, a race-neutral reference equation, was proposed for spirometric interpretation,” the investigators said. “However, the impact of using the GLI-2022 in predicting mortality risk has not been fully investigated.”

To address this gap, a total of 1,989 patients with COPD were enrolled in this prospective cohort study between 2005 and 2022. The investigators then classified participants into GOLD 1 to 4 based on the postbronchodilator forced expiratory volume in 1 s (FEV₁) % predicted using the GLI-2022, GLI Northeast Asian (SLI-2012), Choi’s, and KNHANES-VI reference equations. Different equations were applied to compare the risk of all-cause mortality between GOLD grades.

Some 336 patients died during a median follow-up of 5.0 years. The GLI-2022 estimated lower FEV₁% predicted than those of GLI-2012, Choi’s, and KNHANES-VI. The discrimination or calibration did not differ between the mortality prediction models.

While the GLI-2022 equation discriminated the risk of mortality between the GOLD 1 and 2 groups (adjusted hazard ratio [aHR], 1.46, 95 percent confidence interval [CI], 1.05‒2.03), the race-specific equations did not (Choi’s: aHR, 1.22, 95 percent CI, 0.80‒1.85; KNHANES-VI: aHR, 1.19, 95 percent CI, 0.77‒1.82).

“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,” the investigators said.