对于复发性和竞争性终端事件的关节脆弱模型:在ICU中对妄的应用
Lacey H Etzkorn1, Quentin Le Coënt2, Mark van den Boogaard3
1Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Statistics in medicine
|April 2, 2024
概括
这项研究引入了一种竞争的联合模型,用于分析反复发生的妄想事件以及诸如死亡或重症监护室 (ICU) 的出院等多种结果. 该模型考虑了复杂的关联,改进了对患者康复和生存数据的分析.
科学领域:
- 生物统计学 生物统计学
- 临床流行病学临床流行病学
- 临界护理医学 临界护理医学
背景情况:
- 联合模型对于分析复发性事件和终端事件,如死亡率至关重要.
- 在重症监护病房 (ICU) 中,由于多个可能相互竞争的终端事件 (例如死亡,出院) 导致的反复发生的妄想事件,存在独特的分析挑战.
- 独立的审查假设经常被违反,在分析妄想及其相关结果时偏见推断.
研究的目的:
- 开发和评估用于反复事件过程和多个终端事件的新型竞争性联合模型.
- 在具有竞争风险和复杂关联的场景中解决现有联合模型的局限性.
- 用临床试验和模拟研究的数据来评估拟议模型的性能.
主要方法:
- 一个竞争的联合模型,结合了潜在的脆弱性,将反复发生的妄想事件与竞争的终端事件 (ICU出院,死亡率) 联系起来.
- 该模型应用于用于ICU患者用Haloperidol进行安慰剂对照临床试验的数据.
- 模拟研究评估模型属性,包括偏差和置信区间覆盖率,并与单事件联合模型进行比较.
主要成果:
- 竞争的共同模型有效地将反复的妄想和竞争的终端事件联系在一起,并考虑它们的潜在对立的关联.
- 模拟结果显示了ICU Delirium研究的单一事件联合模型的缺陷.
- 拟议的模型显示了可取的统计性质,提供了更准确的推断.
结论:
- 竞争的联合模型提供了一个强大的框架来分析ICU中的反复 Delirium,考虑多种结果.
- 这种方法减轻了通过违反独立审查假设引入的偏见.
- 该模型可在"脆弱包"R包中获得,以促进其在研究中的应用.
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