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竞争风险调整在心血管风险预测模型中对临床实践的相关性
Steven H J Hageman1, Jannick A N Dorresteijn1, Lisa Pennells2,3
1Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands.
European journal of preventive cardiology
|June 20, 2023
概括
竞争性风险调整对于准确预测高危人群中心血管疾病 (CVD) 风险至关重要. 没有这种调整的模型高估了风险,可能导致过度治疗并影响临床决策.
科学领域:
- 心脏病学 心脏病学
- 生物统计学 生物统计学
- 流行病学 流行病学
背景情况:
- 心血管疾病 (CVD) 风险预测模型通常会解释竞争的非心血管疾病死亡风险.
- 这种调整被认为是为了防止高估累计心血管疾病发病率,特别是在高风险人群中.
- 对于高风险个体的心血管疾病预测模型中竞争性风险调整的临床影响需要评估.
研究的目的:
- 在心血管疾病 (CVD) 预测模型中评估竞争性风险调整的临床影响.
- 为了比较CVD风险预测,在高风险人群中与竞争风险调整以及没有竞争风险调整.
- 为了说明竞争风险调整对治疗资格决定的影响.
主要方法:
- 利用了来自乌得勒支心血管队列-ARTerial疾病的次要表现 (UCC-SMART) 研究的数据.
- 在8355个人中推导出两种10年剩余心血管疾病风险预测模型:一种使用精细和灰色 (竞争性风险),一种使用Cox比例危险 (非竞争性风险).
- 基于风险值的模型预测,高估比率,歧视和治疗资格的比较.
主要成果:
- 没有竞争风险调整的模型产生了更高的平均预测.
- 考克斯模型 (没有调整) 过高估计了累积心脏病发病率 (预测观察比1.14),最显著的是高风险四分位数和老年人.
- 模型之间的歧视是相似的,但未经调整的考克斯模型导致更多人被考虑接受治疗 (44%对34%的风险值>20%).
结论:
- 当竞争风险未经调整时,个人风险预测更高.
- 竞争性风险调整对于准确的绝对风险预测至关重要,特别是在高风险人群中.
- 如果未能调整相应的风险,可能会导致高估并影响临床决策,从而影响治疗资格.
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