Survival models to support shared decision-making about advance care planning for people with advanced stage cystic fibrosis.
Survival models to support shared decision-making about advance care planning for people with advanced stage cystic fibrosis.
复制标题
生存模型，以支持有关高级阶段囊性纤维化患者进行预先护理计划的共同决策。
DOI：
10.1136/bmjresp-2020-000794
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发表时间：
2021-05
影响因子：
4.1
通讯作者：
Lesser ML
中科院分区：
文献类型：
--
作者：
Hajizadeh N;Zhang M;Akerman M;Kohn N;Mathew A;Hadjiliadis D;Wang J;Lesser ML
对于晚期囊性纤维化（CF）患者，量身定制的生存评估有助于在呼吸功能急剧恶化的情况下做出决策。我们使用美国CF基金会国家数据库（2008-2013年）来识别发生晚期CF的成年人（1秒用力呼气量(FEV1)≤预测的45%）。使用lasso方法进行变量选择，我们将数据集分为训练样本和验证样本（2:1），并建立了两个多变量Cox比例风险模型来计算基线（T0模型）和1年后（T12模型）的生存概率。我们还进行了Kaplan-Meier生存分析。共纳入4752人。对于T0车型，FEV1；保险;非侵入式通风;补充氧气;伯克殖民;肝硬化;抑郁症;透析;目前的吸烟;无法分类的突变类型和累积的CF恶化预示着死亡率的增加。基线移植评估状态为“接受，在等待名单上”，预测死亡率降低。对于T12模型，中期FEV1下降10%，肺部恶化也增加了预测死亡率。肺移植与较低死亡率相关。在不考虑任何混杂变量的情况下，4752例中分别有93.5%、86.4%、79.7%和73.9%存活至1年、2年、3年和4年。时间相关的受试者工作特征曲线下的面积表明，模型具有中等的预测能力（T0模型为0.787,95% CI 0.769 ~ 0.794； T12模型为0.779,95% CI 0.767 ~ 0.797）。我们已经开发了预测晚期CF患者生存的模型，这些模型可以随着时间的推移重新应用于支持关于临终治疗选择和肺移植的共同决策。这些估计必须随着CF跨膜电导调节剂治疗患者的长期结果数据的获得而更新。
For people with advanced stage cystic fibrosis (CF), tailored survival estimates could facilitate preparation for decision-making in the event of acutely deteriorating respiratory function. We used the US CF Foundation national database (2008–2013) to identify adult people with incident advanced stage CF (forced expiratory volume in 1 s (FEV1) ≤45% predicted). Using the lasso method for variable selection, we divided the dataset into training and validation samples (2:1), and developed two multivariable Cox proportional hazards models to calculate probabilities of survival from baseline (T0 model), and from 1 year after (T12 model). We also performed Kaplan-Meier survival analyses. 4752 people were included. For the T0 model, FEV1; insurance; non-invasive ventilation; supplemental oxygen; Burkholderia colonisation; cirrhosis; depression; dialysis; current smoking; unclassifiable mutation class and cumulative CF exacerbations predicted increased mortality. Baseline transplant evaluation status of ‘accepted, on waiting list’ predicted decreased mortality. For the T12 model, interim decrease in FEV1 >10%, and pulmonary exacerbations additionally increased predicted mortality. Lung transplantation was associated with lower mortality. Of the 4752, 93.5%, 86.4%, 79.7% and 73.9% survived to 1, 2, 3 and 4 years, respectively, without considering any confounding variables. The models had moderate predictive ability indicated by the area under the time-dependent receiver operating characteristic curve (0.787, 95% CI 0.769 to 0.794 for T0 model; and 0.779, 95% CI 0.767 to 0.797 for T12 model). We have developed models predicting survival in people with incident advanced stage CF, which can be reapplied over time to support shared decision-making about end-of-life treatment choices and lung transplantation. These estimates must be updated as data become available regarding long-term outcomes for people treated with CF transmembrane conductance regulator modulators.
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影响因子：
3.2
作者：
Charles, C;Gafni, A;O'Brien, MA
通讯作者：
O'Brien, MA
DOI：
10.1046/j.1532-5415.2003.51457.x
发表时间：
2003-10-01
影响因子：
6.3
作者：
Fried, TR;Bradley, EH;O'Leary, J
通讯作者：
O'Leary, J
影响因子：
7.2
作者：
Aaron, Shawn D.;Stephenson, Anne L.;Whitmore, George A.
通讯作者：
Whitmore, George A.
影响因子：
5
作者：
Liou, TG;Adler, FR;Marshall, BC
通讯作者：
Marshall, BC
影响因子：
120.7
作者：
CARRESE, JA;RHODES, LA
通讯作者：
RHODES, LA