Prediction tools for unfavourable outcomes in Clostridium difficile infection: a systematic review.
Prediction tools for unfavourable outcomes in Clostridium difficile infection: a systematic review.
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艰难梭菌感染不良结果的预测工具：系统评价。
DOI：
10.1371/journal.pone.0030258
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Valiquette L
中科院分区：
文献类型：
--
作者：
Abou Chakra CN;Pepin J;Valiquette L
随着新疗法的出现，识别有艰难梭菌感染（CDI）不良后果风险的患者，包括复发和死亡，将变得越来越重要，这些新疗法比传统方法更有效，但非常昂贵。临床预测规则（CPRs）可以提高医疗决策的准确性。已经为CDI开发了几种cpr，但没有一种获得广泛接受。我们系统地回顾了医学数据库（Medline、Embase、PubMed、Web of Science和Cochrane）和会议摘要中描述cpr衍生或验证CDI不利结果的研究。在筛选的2945篇标题和摘要中，确定了13项关于CPR衍生的研究：2项关于复发率，5项关于并发症（包括死亡率），5项关于单独死亡率，1项关于治疗反应。还检索了两项关于不同严重程度指标验证的研究。大多数CPRs是作为二次分析开发的，使用了为其他目的而聚集的队列。CPRs在方法上存在一些局限性，这可以解释其在临床实践中应用有限的原因。除了白细胞、白蛋白和年龄外，所使用的变量存在很大的异质性，而且大多数研究受样本量小的限制。8个模型采用回顾性设计。只有四项研究报告了感兴趣的结果的发生率，即使这对于评估模型在其他人群中的潜在有用性是必不可少的。只有5项研究进行了多变量分析以调整混杂因素。缺乏称重变量、验证、校准和可重复性测量，评估时的弱效度和性能，以及缺乏敏感性分析，都导致这些cpr的质量不理想，效用值得商榷。通过适当的前瞻性队列开发的循证工具对临床医生来说比经验性开发的cpr更有价值。
Identifying patients at risk for adverse outcomes of Clostridium difficile infection (CDI), including recurrence and death, will become increasingly important as novel therapies emerge, which are more effective than traditional approaches but very expensive. Clinical prediction rules (CPRs) can improve the accuracy of medical decision-making. Several CPRs have been developed for CDI, but none has gained a widespread acceptance. We systematically reviewed studies describing the derivation or validation of CPRs for unfavourable outcomes of CDI, in medical databases (Medline, Embase, PubMed, Web of Science and Cochrane) and abstracts of conferences. Of 2945 titles and abstracts screened, 13 studies on the derivation of a CPR were identified: two on recurrences, five on complications (including mortality), five on mortality alone and one on response to treatment. Two studies on the validation of different severity indices were also retrieved. Most CPRs were developed as secondary analyses using cohorts assembled for other purposes. CPRs presented several methodological limitations that could explain their limited use in clinical practice. Except for leukocytosis, albumin and age, there was much heterogeneity in the variables used, and most studies were limited by small sample sizes. Eight models used a retrospective design. Only four studies reported the incidence of the outcome of interest, even if this is essential to evaluate the potential usefulness of a model in other populations. Only five studies performed multivariate analyses to adjust for confounders. The lack of weighing variables, of validation, calibration and measures of reproducibility, the weak validities and performances when assessed, and the absence of sensitivity analyses, all led to suboptimal quality and debatable utility of those CPRs. Evidence-based tools developed through appropriate prospective cohorts would be more valuable for clinicians than empirically-developed CPRs.
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影响因子：
29.4
作者：
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通讯作者：
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