Win Ratio in Biomedical Science: A Bibliometric Analysis

The win ratio (WR), introduced in 2012, has emerged as a method to analyze hierarchical composite outcomes by prioritizing clinically significant events, unlike traditional composite time-to-event analyses, which treat events equally. However, use of the WR in biomedical research beyond cardiovascular trials remains unexplored. The study aims to investigate trends in the use of the WR in biomedical research and determine the characteristics of these articles.

Biomedical articles indexed in Web of Science and PubMed were retrieved for 2012-2024. Data extraction included bibliometric information and content details. Statistical analyses utilized descriptive statistics, correlation, and linear regression to assess publication trends and the distribution of WR methodologies across disciplines.

A total of 82 studies were analyzed. Publication counts using the WR have grown significantly since its introduction, with an annual compounded growth rate of 30.2%. Most articles were randomized controlled trials (n = 68; 82.9%). Of the 68 randomized controlled trials, 46 (67.6%) were in the field of cardiology. The unmatched WR was the predominant WR approach (n = 57; 69.5%). Mortality was the highest-ranked outcome in most studies (n = 55; 67.1%), and time-to-event variables were the most frequently used across all hierarchical outcome ranks (n = 173).

The WR has gained acceptance as a robust and clinically meaningful method for analyzing composite endpoints, particularly for cardiovascular trials. Although challenges remain, its adaptability and ability to prioritize clinically relevant outcomes make it a promising tool for future biomedical research across various disciplines.