在免疫媒介炎症疾病中对甲状腺素毒性的风险分层监测:使用来自英国的初级保健数据开发和验证预后模型
Georgina Nakafero1, Matthew J Grainge2, Hywel C Williams2
1Academic Rheumatology, University of Nottingham, Nottingham NG5 1PB, UK.
BMJ (Clinical research ed.)
|May 30, 2023
概括
一个新的预后模型有助于医生决定长期接受甲状腺素治疗的患者的血液检测频率. 这种工具有助于免疫媒介炎症疾病的风险分层.
科学领域:
- 药物监测和临床风险管理
- 免疫学和风湿病学
- 卫生信息学和数据科学
背景情况:
- 长期的甲索特雷克萨治疗对于免疫媒介性炎症性疾病 (IMIDs) 是常见的.
- 监测血液测试至关重要,但频率可能会有所不同.
- 优化监测频率平衡了患者安全和医疗保健资源利用.
研究的目的:
- 开发和验证一种预后模型,用于风险分层监测血液检测频率.
- 根据临床决策,对长期接受甲状腺素治疗的患者进行管理.
主要方法:
- 使用英国临床实践研究数据链 (CPRD) 黄金和Aurum数据的回顾性队列研究.
- 包括成年患者 (≥18岁) 与IMID处方甲状腺素≥6个月 (2007-19).
- 考克斯回归和引导被用来开发和验证预后模型,评估校准和歧视.
主要成果:
- 这项研究包括超过13,000名 (开发) 和23,000名 (验证) 参与者.
- 开发的预后模型在预测结果方面表现良好 (乐观度调整后的R2=0.13,开发中的Royston D=0.79;校准斜率=0.94,验证中的Royston D=0.75).
- 该模型在临床相关的子组 (年龄,IMID类型,甲铁酸剂量) 中表现良好.
结论:
- 有一个经验证的预后模型可用于指导长期使用甲状腺素的血液检测监测的频率.
- 该工具利用常规临床数据,支持风险分层的患者管理.
- 该模型有助于优化患者护理和风湿病学和免疫学资源配置.
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