Ke Huang,1,* Xingyao Tang,1,2,* Xu Chu,1,* Hongtao Niu,1 Wei Li,1 Zhoude Zheng,1,3 Yaodie Peng,1,3 Jieping Lei,4 Yong Li,1 Baicun Li,1 Ting Yang,1 Chen Wang1,5 

1Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China; State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People’s Republic of China; 2Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China; 3Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China; 4Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 5School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Baicun Li; Ting Yang, Email dryangting@qq.com

Background: The STAR staging standard has been demonstrated to have good performance in distinguishing mortality among patients at different stages. However, the effectiveness of STAR and GOLD staging in distinguishing disease severity in high-risk and COPD patients remained unclear.
Methods: Based on Enjoying Breathing Program data through June 2023, a total of 7.924 high-risk and COPD patients were included. STAR and GOLD severity stages were based on FEV1/FVC (0.6– 0.7, 0.5– 0.6, 0.4– 0.5, and < 0.4 for stage 1 to 4 in STAR) and the proportion of predicted FEV1 value (≥ 80%, 50%-80%, 30%-50%, and < 30% for stage 1 to 4 in GOLD), respectively. The cox regression model was used to assess the risk of medical visit due to severe respiratory symptoms according to STAR and GOLD.
Results: The current study included 1603 high-risk individuals and 6321 COPD patients. The proportions of STAR 1– 4 in COPD patients were 37.1%, 33.2%, 20.5%, and 9.2%, respectively. In COPD patients only, GOLD stage distinguished disease severity well, but there was no difference in the risk of exacerbation between the different STAR stage groups. In addition, in COPD patients, by considering of GOLD and STAR together, GOLD 3 and 4 can provide more information about the exacerbation based on each STAR level, and STAR 1 and 2 can provide more information about the exacerbation in GOLD 2– 4. COPD patients with GOLD 4 and STAR 2 (HR=4.08, 95% CI: 2.75– 6.04) had the highest risk of exacerbation, followed by COPD patients with GOLD 4 and STAR 1 (HR=3.94, 95% CI: 2.49– 6.23).
Conclusion: In COPD patients, GOLD performs better than STAR in predicting exacerbation risk. In addition, the combination of GOLD and STAR can provide more information, especially for COPD patients with GOLD 4 and STAR 1– 2, which should be paid more attention in treatment and disease management.

Keywords: COPD, STAR, GOLD, disease severity