Prediction models for the mortality risk in chronic dialysis patients: a systematic review and independent external validation study.
Prediction models for the mortality risk in chronic dialysis patients: a systematic review and independent external validation study.
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DOI：
10.2147/clep.s139748
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发表时间：
2017
影响因子：
3.9
通讯作者：
van Diepen M
中科院分区：
文献类型：
--
作者：
Ramspek CL;Voskamp PW;van Ittersum FJ;Krediet RT;Dekker FW;van Diepen M
在医学中，已经开发出的预测模型比在临床实践中实现或使用的要多得多。在建立外部有效性之前，不能推荐这些模型用于临床。尽管已经发表了各种预测透析患者死亡率的模型，但很少有模型得到验证，也没有一个模型用于常规临床实践。本研究的目的是通过审查确定用于预测透析患者死亡率的现有模型，随后在同一大型独立患者队列中对这些模型进行外部验证，以评估和比较其预测能力。按照系统性综述和荟萃分析（PRISMA）指南的首选报告项目进行系统性综述。为了解释缺失数据，进行了多重插补。原始预测公式是从选定的研究中提取的。在荷兰透析耐受性合作研究（NECOSAD）中，计算每种模型的死亡概率。模型的预测性能进行了评估的基础上，他们的歧视和校准。共有16篇文章被纳入系统综述。在来自NECOSAD的1，943名透析患者中进行了外部确认，共使用了7种型号。模型在辨别力方面表现中等至良好，在1年的时间范围内，C统计量范围为0.710（四分位数范围0.708-0.711）至0.752（四分位数范围0.750-0.753）。根据校准，大多数模型高估了死亡概率。总体而言，外部验证中模型的性能比原始人群差，肯定了外部验证的重要性。Floege等人的模型显示出最高的预测性能。本研究是一个进步，在使用预测模型作为一个有用的工具，肾脏病学家，使用循证医学，结合个人的临床专业知识，患者的选择，和最好的外部证据。
In medicine, many more prediction models have been developed than are implemented or used in clinical practice. These models cannot be recommended for clinical use before external validity is established. Though various models to predict mortality in dialysis patients have been published, very few have been validated and none are used in routine clinical practice. The aim of the current study was to identify existing models for predicting mortality in dialysis patients through a review and subsequently to externally validate these models in the same large independent patient cohort, in order to assess and compare their predictive capacities. A systematic review was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. To account for missing data, multiple imputation was performed. The original prediction formulae were extracted from selected studies. The probability of death per model was calculated for each individual within the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD). The predictive performance of the models was assessed based on their discrimination and calibration. In total, 16 articles were included in the systematic review. External validation was performed in 1,943 dialysis patients from NECOSAD for a total of seven models. The models performed moderately to well in terms of discrimination, with C-statistics ranging from 0.710 (interquartile range 0.708–0.711) to 0.752 (interquartile range 0.750–0.753) for a time frame of 1 year. According to the calibration, most models overestimated the probability of death. Overall, the performance of the models was poorer in the external validation than in the original population, affirming the importance of external validation. Floege et al’s models showed the highest predictive performance. The present study is a step forward in the use of a prediction model as a useful tool for nephrologists, using evidence-based medicine that combines individual clinical expertise, patients’ choices, and the best available external evidence.