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为什么随访在生存分析中很重要:比较cox比例危险回归和随机生存森林来预测心力衰竭结果
Emrah Gökay Özgür1, Gülnaz Nural Bekiroğlu2
1Department of Biostatistics, School of Medicine, Marmara University, Istanbul, Türkiye. emrahgokayozgur@gmail.com.
BMC cardiovascular disorders
|September 27, 2025
概括
改善心力衰竭生存预测的随访充分性可以提高模型的性能. 随机生存森林模型显示出优异的预测准确性和稳定性,与随着随访增加的考克斯回归相比.
科学领域:
- 心血管医学 心血管医学
- 生物统计学 生物统计学
- 医疗信息学 医疗信息学
背景情况:
- 心力衰竭 (HF) 是一个重大的全球健康挑战,死亡率高.
- 准确的生存预测对于HF患者的有效临床管理至关重要.
- 本研究研究了随访充分性的影响,通过人与时间的随访率 (PTFR) 衡量,对生存模型的性能.
研究的目的:
- 评估不同级别的后续足够性如何影响考克斯比例危险回归 (CPHR) 和随机生存森林 (RSF) 模型的性能.
- 在不同的PTFR条件下比较CPHR和RSF的预测准确性和稳定性.
- 通过使用强大的建模技术,确定心力衰竭患者生存的关键预测因素.
主要方法:
- 对299名心力衰竭患者的例行收集数据集的分析.
- 使用Xue等人通过正式方法计算人与时间的随访率 (PTFR). (2022年) 的第二季.
- 模拟一组数据集,以比例延长后续时间来增加PTFR,然后应用CPHR和RSF模型,通过C指数和曲线下面面积 (AUC) 评估性能.
主要成果:
- 随机生存森林 (RSF) 模型在原始数据集中的Cox比例危险回归 (CPHR) (C-index: 0.754,AUC: 0.959) 相比,显示出更高的性能 (C指数: 0.884,AUC: 0.988).
- 模型性能,特别是RSF,在模拟数据集中,随着PTFR的增加,模型性能呈现出改善.
- 较高的PTFR与增强的模型稳定性和预测准确性相关,RSF更有效地识别了重要的临床预测因子,如射出分数和血清肌素.
结论:
- 通过更高的PTFR反映的适当的随访对于改善心力衰竭生存预测模型的有效性和稳定性至关重要.
- 随机生存森林 (RSF) 始终优于考克斯回归,特别是随着后续足够性的改善.
- 建议增加PTFR的策略,例如延长随访时间和整合多种数据源,以增强临床生存分析中的预测建模.
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