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在不断变化的环境中对临床生存预测模型的动态更新
Kamaryn T Tanner1, Ruth H Keogh2, Carol A C Coupland3,4
1Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. kamaryn.tanner1@lshtm.ac.uk.
Diagnostic and prognostic research
|December 12, 2023
概括
临床生存模型的动态更新比一次性更新提高了性能. 贝叶斯更新是有效的,特别是在新的预测和有限的数据,在各种场景中表现优于其他方法.
科学领域:
- 临床流行病学 临床流行病学
- 生物统计学 生物统计学
- 医疗信息学 医疗信息学
背景情况:
- 临床预测模型需要更新,因为医疗保健景观不断变化.
- 以前的研究主要集中在二进制结果上,需要扩展时间到事件模型.
- 随着COVID-19的爆发,人们越来越需要在动态环境中使用适应性模型.
研究的目的:
- 研究临床生存预测模型的动态更新策略.
- 为了比较贝叶斯的动态更新,重新校准和完整的重新调整方法.
- 将动态更新研究扩展到时间到事件结果.
主要方法:
- 我们比较了三个动态更新方法:贝叶斯式,重新校准和重新调整.
- 利用模拟研究,使用不同的死亡率,预测器流行率和新的治疗方法.
- 在使用英国电子健康记录的COVID-19死亡预测模型中应用更新策略.
主要成果:
- 动态更新在模拟中始终优于离散更新和没有更新.
- 贝叶斯更新在具有新预测因素和小数据集的场景中增强了C指数.
- 截断再校准在较小的样本大小和改变基线危险的情况下显示出有效性.
结论:
- 动态更新过程优于生存模型的一次性离散更新.
- 贝叶斯更新在各种场景中提供了强大的性能,包括新的预测器.
- 模型更新策略应考虑样本大小和结果稀有性,以获得最佳性能.
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