ArticleJournal of global health2026
The high-risk B-to-E transitional phenotype: a prospective multi-centre validation of patient reclassification under the updated GOLD 2026 criteria.
Article in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 criteria lowered the threshold for classifying Group E to ≥1 moderate or severe acute exacerbation in the last year. However, the scale of patient reclassification and its clinical justification in real-world settings have not been validated. Methods: We utilised a prospective, multi-centre Chinese chronic obstructive pulmonary disease (COPD) cohort (n = 966), and applied the GOLD 2015, 2025, and 2026 criteria to the same cohort, focusing on patients who shifted from group B under GOLD 2025 to group E under GOLD 2026. The primary outcome was time to first moderate-to-severe acute exacerbation; secondary outcomes included symptom burden, health care resource utilisation, and clinical features of patients in the subgroups. Results: Of 952 analysable participants, 242 were classified as shift-to-E. During an average follow-up of 10.3 months, the shift-to-E subgroup showed a 92% higher risk than stable B (hazard ratio (HR) = 1.92; 95% confidence interval (CI) = 1.14-3.23, P = 0.01441). Its adjusted follow-up scores of the COPD assessment test (CAT = 14.83) and the modified Medical Research Council dyspnoea scale (mMRC = 2.191) were comparable to stable E (CAT = 15.30 and mMRC = 2.214) and significantly higher than stable B. The subgroup also had longer baseline hospital stays (12.31 days) than stable B (8.246 days), supporting the utility of the GOLD 2026 for precise COPD stratification. Conclusions: The GOLD 2026 update effectively identifies a substantial subgroup of patients with a distinct high-risk B-E transitional phenotype. Their exacerbation risk and symptom burden approximate those of the traditional high-risk group E, providing direct prognostic evidence for treatment escalation based on a history of just one moderate exacerbation. This supports the clinical utility of the new criteria for precise risk stratification. Registration: Chinese Clinical Trial Registry (ChiCTR-POC-17010431).
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