Modeling the effect of time-dependent exposure on intensive care unit mortality

To illustrate modern survival models with focus on the temporal dynamics of intensive care data. A typical situation is given in which time-dependent exposures and competing events are present.

We briefly review the following established statistical methods: logistic regression, regression models for event-specific hazards and the subdistribution hazard. These approaches are compared by showing advantages as well as disadvantages. All methods are applied to real data from a study of day-by-day ICU surveillance.

Standard logistic regression ignores the time-dependent nature of the data and is only a crude approach. Cumulative hazards and probability plots add important information and provide a deep insight into the temporal dynamics.

This paper might help to encourage researchers working in hospital epidemiology to apply adequate statistical models to complex medical questions.