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慢性阻塞性肺病患者预后预测模型的系统评价
作者:小柯机器人 发布时间:2019/10/10 10:54:50

希腊约阿尼纳大学医学院Evangelos Evangelou研究团队系统分析和批判评价了慢性阻塞性肺病(COPD)患者预后的预测模型。这一研究成果于2019年10月4日在线发表于《英国医学杂志》。

研究组系统搜索了228篇符合条件的文献,描述了408个预后模型的开发,38个模型的外部验证,以及20个针对COPD以外疾病预后模型的验证。408个预后模型建立于三个临床环境:239个针对门诊患者,155个针对住院患者,14个针对急诊患者。这408个预后模型中,最普遍的终点是死亡率(209个,占51%)、COPD急性加重(42个,10%)和再次住院的风险(36个,9%)。

总体来说,最常用的预测因素是年龄(41%)、一秒用力呼气量(21%)、性别(18%)、体重指数(16%)和吸烟(16%)。在408个预后模型中,100个(25%)得到了内部验证,91个(23%)检测了校准开发模型。286个(70%)模型无法展示,只有56个(14%)模型可通过完整方程式展示。C统计模型可对311个(76%)模型进行判别。38个模型进行了外部验证,但其中只有12个由一个完全独立的团队进行验证。只有7个预后模型的总体偏倚风险较低。

总之,该研究对COPD患者预后预测模型进行了详细的描绘和评估,发现它们的开发过程存在一些方法上的缺陷,且外部验证率较低。未来的研究应着眼于通过更新和外部验证来对现有的这些模型进行改进,并在临床实践中对它们的安全性、临床有效性和成本效益进行评估。

附:英文原文

Title: Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal

Author: Vanesa Bellou, Lazaros Belbasis, Athanasios K Konstantinidis, Ioanna Tzoulaki, Evangelos Evangelou

Issue&Volume: 2019/10/04

Abstract: 

Objective To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD).

Design Systematic review.

Data sources PubMed until November 2018 and hand searched references from eligible articles.

Eligibility criteria for study selection Studies developing, validating, or updating a prediction model in COPD patients and focusing on any potential clinical outcome.

Results The systematic search yielded 228 eligible articles, describing the development of 408 prognostic models, the external validation of 38 models, and the validation of 20 prognostic models derived for diseases other than COPD. The 408 prognostic models were developed in three clinical settings: outpatients (n=239; 59%), patients admitted to hospital (n=155; 38%), and patients attending the emergency department (n=14; 3%). Among the 408 prognostic models, the most prevalent endpoints were mortality (n=209; 51%), risk for acute exacerbation of COPD (n=42; 10%), and risk for readmission after the index hospital admission (n=36; 9%). Overall, the most commonly used predictors were age (n=166; 41%), forced expiratory volume in one second (n=85; 21%), sex (n=74; 18%), body mass index (n=66; 16%), and smoking (n=65; 16%). Of the 408 prognostic models, 100 (25%) were internally validated and 91 (23%) examined the calibration of the developed model. For 286 (70%) models a model presentation was not available, and only 56 (14%) models were presented through the full equation. Model discrimination using the C statistic was available for 311 (76%) models. 38 models were externally validated, but in only 12 of these was the validation performed by a fully independent team. Only seven prognostic models with an overall low risk of bias according to PROBAST were identified. These models were ADO, B-AE-D, B-AE-D-C, extended ADO, updated ADO, updated BODE, and a model developed by Bertens et al. A meta-analysis of C statistics was performed for 12 prognostic models, and the summary estimates ranged from 0.611 to 0.769.

Conclusions This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients. The findings indicate several methodological pitfalls in their development and a low rate of external validation. Future research should focus on the improvement of existing models through update and external validation, as well as the assessment of the safety, clinical effectiveness, and cost effectiveness of the application of these prognostic models in clinical practice through impact studies.

DOI: 10.1136/bmj.l5358

Source: https://www.bmj.com/content/367/bmj.l5358

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj