Evaluation of exacerbation severity in patients with COPD exacerbations according to the GOLD 2023 report

The criteria for COPD exacerbation were redefined in the GOLD 2023 report. This study aimed to evaluate and compare the severity of exacerbations in patients hospitalized with COPD exacerbations [ECOPD] based on the new severity classification defined in the GOLD 2023 report. A prospective, cross-sectional, and observational study included a total of 513 ECOPD patients from nine university hospitals. Patients were classified into three groups according to the GOLD 2023 COPD exacerbation severity criteria. The mean age of the total patients was 68.9 ± 8.8 years, with 83.4% being male. The distribution of exacerbation severity was as follows: mild [24.4%], moderate [50.8%], and severe [24.8%]. The rate of ICU admission [0.8%-4.2%-27.5%] and in-hospital mortality [1.6%-3.9%-9.2%] increased progressively from the mild to the severe exacerbation group [p < 0.001; p = 0.012, respectively]. Factors affecting 180-day mortality included age, smoking pack-years, mMRC score, hypoxemia, elevated CRP, low HCT, low eosinophil, CCI, and experiencing moderate to severe exacerbations. Severe exacerbations were associated with COPD duration, smoking pack-years, mMRC score, hypoxemia, low eosinophil, reduced FEV1%, and treatment non-adherence. Our study demonstrates that the new ECOPD severity classification is a distinctive and objective tool for predicting ICU admission and in-hospital mortality.