对超越Framingham风险评分的预测改进的要求进行评估
Ioanna Tzoulaki1, George Liberopoulos, John P A Ioannidis
1Department of Epidemiology and Public Health, Imperial College of Medicine, London, England.
JAMA
|December 3, 2009
概括
许多研究声称使用额外因素的弗雷明汉风险评分 (FRS) 提高了预测. 然而,大多数研究都存在设计和分析缺陷,这使得他们对临床预测的发现产生了怀疑.
科学领域:
- 临床预测建模临床预测建模
- 心血管风险评估心血管风险评估
- 基于证据的医学是基于证据的医学.
背景情况:
- 预测医学正在进步,许多研究旨在提高对主要临床结果的预测.
- 弗雷明汉风险评分 (FRS) 是一个被广泛验证和引用的临床预测评分.
研究的目的:
- 评估研究的设计和分析,评估额外的预测因子是否会在添加到FRS时改善预测性能.
- 识别可能影响预测能力报告的改善的研究方法的缺陷.
主要方法:
- 对引用FRS的文章进行了系统的搜索 (1998-2009).
- 符合条件的研究比较了仅FRS的预测性能与FRS加其他预测因素.
- 记录了FRS计算,预测模型,结果,种群,子组分析和方法缺陷的数据.
主要成果:
- 评估了79项研究,62%没有按照建议计算FRS,52%没有使用原始结果.
- 80%的研究声称改善了预测,但方法上的缺陷很常见.
- 曲线下的增加面积 (AUC) 与较低的FRS性能和分析文件不足有关.
结论:
- 大多数研究声称FRS以外的额外预测价值.
- 研究设计,分析和报告中的重大缺陷使人们对这些说法的可靠性产生了担忧.
- 需要使用严格的方法进行进一步的研究,以验证临床使用的额外预测因子.
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