较高与较低质量的证据代表真实效应估计的概率是多少?
Benjamin Djulbegovic1, Iztok Hozo2, Despina Koletsi3,4
1Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Journal of evaluation in clinical practice
|October 7, 2024
概括
证据确定性 (CoE) 评级系统显示了与真正治疗效应的概率的线性关系. 每次 CoE 评级下降一级,就会使真正影响的可能性降低约 20%.
科学领域:
- 医学研究方法论医学研究方法论.
- 基于证据的医学是基于证据的医学.
- 生物统计学 生物统计学
背景情况:
- 建议评估,发展和评价 (GRADE) 系统的分级被广泛用于评估证据的确定性 (CoE).
- 以前的研究表明,GRADE可能无法可靠地区分CoE水平来评估治疗效果的大小.
- 估计的效果大小受到真实效应,偏差和非线性因素的影响.
研究的目的:
- 调查是否简单的线性统计的证据可以提供更准确的估计的真实治疗效应的概率基于CE.
- 确定CoE水平与真实治疗效应估计概率之间的关系.
主要方法:
- 从更新前后的元分析 (MAs) 中比较的赔率比率 (ORs).
- 分析了82对 Cochrane MAs,其中 CoE 保持不变.
- 计算了几率比率 (ROR) 的比率,以评估效应估计的时间稳定性,假设ROR=1表明真实性.
主要成果:
- 在CoE和"真实"治疗效果估计的概率 (R2=1,p=0.001) 之间发现了显著的线性关系,ROR误差幅度为10%.
- "真实"估计的概率下降了21% (95% CI:18%-24%) 在Coe评级的每一步下降.
- 较高的CoE显示出真正效应的概率 (53%) 与非高的CoE (25%;p=0.032) 相比显著更高.
结论:
- 证实了 CoE 和潜在真实治疗效果估计的概率之间的线性关系.
- 每次 CoE 评级下降一级,都会使真实效应的概率降低大约 20%.
- 真正估计的概率从高Coe的80%~至非常低Coe的15%~.
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