在评估危急疾病幸存者的长期结果时,考虑竞争事件
Federico Angriman1,2,3, Bruno L Ferreyro2,3,4, Michael O Harhay5
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
American journal of respiratory and critical care medicine
|September 28, 2023
概括
评估危急疾病幸存者的长期结果是复杂的,因为死亡等竞争事件. 本研究探讨了在这些事件发生时准确分析生存数据的方法,改进了结果评估.
科学领域:
- 关键护理医学 关键护理医学
- 生物统计学 生物统计学
- 流行病学 流行病学
背景情况:
- 对于重症幸存者的长期结果是复杂和不可预测的.
- 评估这些结果是具有挑战性的,因为竞争事件,如所有原因的死亡率,这可能会偏向传统的生存分析.
- 卡普兰-梅尔和标准考克斯模型在存在竞争事件时可能会提供偏差的估计.
研究的目的:
- 探索竞争性事件的挑战和方法影响,以评估重症幸存者的长期结果.
- 介绍各种分析方法来处理生存数据中的竞争事件.
- 为适当的统计方法和报告提供指导.
主要方法:
- 审查传统的生存分析方法 (卡普兰-梅尔,考克斯模型) 和它们与竞争事件的局限性.
- 讨论替代估计和分析策略.
- 探索精细和灰色回归模型,因果特定的考克斯模型,以及诸如反向概率权重等一般化方法.
- 使用模拟数据集和代码示例来说明分析应用.
主要成果:
- 传统的生存分析方法可以在存在竞争事件时产生偏差的估计.
- 像Fine和Gray模型,因果特异性Cox模型和反向概率权重等替代方法提供了更准确的评估.
- 方法的选择取决于具体的研究问题和估计的兴趣.
结论:
- 对重症幸存者的长期结果的准确评估需要仔细考虑竞争事件.
- 除了传统的生存分析之外,还需要适当的统计方法来进行公正的估计.
- 采用推的分析策略和报告标准对于该领域的可靠研究至关重要.
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