预测功能衰竭风险方程准确性的跨国评估:一个元分析
Navdeep Tangri1, Morgan E Grams2, Andrew S Levey3
1Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada2Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada.
JAMA
|January 13, 2016
概括
在全球范围内,衰竭风险方程的准确性很高. 在非北美人群中,可能需要进行校准调整,以改善慢性病 (CKD) 进展的预测.
科学领域:
- 肝脏病学
- 流行病学
- 生物统计学
背景情况:
- 鉴定患有慢性病 (CKD) 进展风险的患者对于有效的病治疗至关重要.
- 现有的功能衰竭风险方程需要在全球不同人群和非科医生管理的慢性病患者中进行验证.
研究的目的:
- 评估不同地理区域和患者人口统计数据中确定的功能衰竭风险方程的准确性.
- 通过个人参与者数据的元分析,评估这些风险预测工具的区域校准需求.
主要方法:
- 对31个群体的个人参与者数据进行了元分析,其中包括来自30多个国家的721,357名患有3-5阶段的CKD参与者.
- 分析了1982-2014年间收集的数据,以估计队列特定的危险比率,并将其结合起来形成综合功能衰竭风险方程.
主要成果:
- 最初的功能衰竭风险方程显示出不同群体的优异差异 (C-统计值为0. 90在2年,0. 88在5年).
- 虽然在北美进行校准是充足的,但在一些非北美群体中风险被高估;在这些地区添加校准因子提高了准确性.
结论:
- 在加拿大开发的功能衰竭风险方程在全球范围内具有很高的区别性和适当的校准性.
- 在某些非北美人群中,区域校准因子可能是必要的,以提高功能衰竭风险预测的准确性.
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