从日历时间的截面中对末期肝病的模型进行修订,并对选择偏差进行了校正
H C de Ferrante1,2, M van Rosmalen3, B M L Smeulders4
1Department of Mathematics and Computer Science, Eindhoven University of Technology, 5600MB, Eindhoven, PO Box 513, Netherlands. h.c.d.ferrante@tue.nl.
BMC medical research methodology
|February 28, 2024
概括
修订后的末期肝病模型 (MELD) 评分,DynReMELD,改善了肝移植候选人的90天候 lista生存预测. 这个动态修订使用日历时间的截面,并考虑信息审查,提高准确性.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 生物统计学 生物统计学
背景情况:
- 肝移植候选人优先考虑依赖于末期肝病模型 (MELD) 评分.
- 当前的MELD修订经常忽略后注册数据和信息审查.
- 这项研究解决了现有的MELD评分修订的局限性.
研究的目的:
- 使用日历时间截面和反向概率审查权重 (IPCW) 修改UNOS-MELD得分.
- 开发一个动态修订的MELD得分 (DynReMELD) 以改善等候名单死亡率预测.
- 为了比较DynReMELD与UNOS-MELD和之前的修订 (ReMELD) 的性能.
主要方法:
- 在欧洲移植肝硬化患者 (2007-2019,n=13,274) 上使用了Cox模型.
- 员工每周日历时间截面和IPCW用于MELD修订.
- 从注册和截面进行90天的评估生存期.
主要成果:
- 日历时间的截面修改产生了不同的MELD系数.
- IPCW将90天等候名单绝对死亡风险估计增加了10%左右.
- 在DynReMELD的研究中,与UNOS-MELD和ReMELD相比,DynReMELD的歧视情况有所改善 (p < 0.01).
结论:
- 纠正选择偏差并没有增加歧视,但增加了死亡风险估计.
- 从横截面的修订有效地使用等待列表数据.
- 与仅基于上市信息的MELD分数相比,DynReMELD显示出更高的歧视.
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