Systematic review of prediction models for pulmonary tuberculosis treatment outcomes in adults.
Systematic review of prediction models for pulmonary tuberculosis treatment outcomes in adults.
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DOI：
10.1136/bmjopen-2020-044687
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发表时间：
2021-03-02
期刊：
影响因子：
2.9
通讯作者：
Sterling TR
中科院分区：
文献类型：
--
作者：
Peetluk LS;Ridolfi FM;Rebeiro PF;Liu D;Rolla VC;Sterling TR
系统回顾和批判性评价用于预测成人肺结核（TB）治疗结局的预测模型。系统评价。检索了PubMed、Embase、Web of Science和Google Scholar中1995年1月1日至2020年1月9日发表的研究。纳入了开发模型来预测肺结核治疗结果的研究。研究筛选、数据提取和质量评估由两名评审员独立进行。使用预测模型偏差风险评估工具评估研究质量。通过叙述性审查和图表对数据进行了综合。共识别出14739篇文章，536篇进行了全文综述，纳入了33项研究，其中33项研究提出了37种预测模型。模型结局包括死亡（n=16，43%）、治疗失败（n=6，16%）、违约（n=6，16%）或复合结局（n=9，25%）。大多数模型（n=30，81%）测量了区分度（中位数c-统计量=0.75; IQR：0.68-0.84），17个（46%）报告了校准，通常是Hosmer-Lemeshow检验（n=13）。19个（51%）模型进行了内部验证，6个（16%）进行了外部验证。18项（54%）研究提到了缺失数据，其中一半（n=9）使用了完整的病例分析。最常见的预测因素包括年龄、性别、肺外结核、体重指数、胸部X光检查结果、既往结核病史和艾滋病毒感染史。偏倚风险因研究而异，但所有研究在分析中均存在高偏倚风险。结核病结果预测模型是异质的，具有不同的结果定义、预测因子和方法。我们不建议在没有外部验证的情况下在临床环境中应用任何预测模型，并鼓励未来的研究人员遵守开发和报告预测模型的指南。该研究已在PROSPERO系统综述国际前瞻性注册库（CRD 42020155782）中注册
To systematically review and critically evaluate prediction models developed to predict tuberculosis (TB) treatment outcomes among adults with pulmonary TB. Systematic review. PubMed, Embase, Web of Science and Google Scholar were searched for studies published from 1 January 1995 to 9 January 2020. Studies that developed a model to predict pulmonary TB treatment outcomes were included. Study screening, data extraction and quality assessment were conducted independently by two reviewers. Study quality was evaluated using the Prediction model Risk Of Bias Assessment Tool. Data were synthesised with narrative review and in tables and figures. 14 739 articles were identified, 536 underwent full-text review and 33 studies presenting 37 prediction models were included. Model outcomes included death (n=16, 43%), treatment failure (n=6, 16%), default (n=6, 16%) or a composite outcome (n=9, 25%). Most models (n=30, 81%) measured discrimination (median c-statistic=0.75; IQR: 0.68–0.84), and 17 (46%) reported calibration, often the Hosmer-Lemeshow test (n=13). Nineteen (51%) models were internally validated, and six (16%) were externally validated. Eighteen (54%) studies mentioned missing data, and of those, half (n=9) used complete case analysis. The most common predictors included age, sex, extrapulmonary TB, body mass index, chest X-ray results, previous TB and HIV. Risk of bias varied across studies, but all studies had high risk of bias in their analysis. TB outcome prediction models are heterogeneous with disparate outcome definitions, predictors and methodology. We do not recommend applying any in clinical settings without external validation, and encourage future researchers adhere to guidelines for developing and reporting of prediction models. The study was registered on the international prospective register of systematic reviews PROSPERO (CRD42020155782)
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影响因子：
39.2
作者：
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