Estimating the Comparative Effectiveness of Feeding Interventions in the Pediatric Intensive Care Unit: A Demonstration of Longitudinal Targeted Maximum Likelihood Estimation.
Estimating the Comparative Effectiveness of Feeding Interventions in the Pediatric Intensive Care Unit: A Demonstration of Longitudinal Targeted Maximum Likelihood Estimation.
复制标题
DOI：
10.1093/aje/kwx213
复制
发表时间：
2017-12-15
影响因子：
5
通讯作者：
Petersen M
中科院分区：
文献类型：
--
作者：
Kreif N;Tran L;Grieve R;De Stavola B;Tasker RC;Petersen M
纵向数据来源为顺序干预的评估提供了新的机会。为了调整这些设置中的时间相关混淆，提出了纵向目标最大似然估计（TMLE），这是一种可以与机器学习相结合的双重鲁棒方法。本文提供了一个应用纵向TMLE的教程，而不是基于迭代条件期望的处理加权逆概率和g计算。在英国的一项研究中，我们应用这些方法来估计营养干预对危重儿童临床结果的因果效应（《儿科重症监护中的高血糖控制》，2008-2011）。我们估计儿童在某一天从儿科重症监护病房活着出院的概率，在一系列静态和动态喂养制度下。我们发现，调整前，按照静态方案“从不进食”的患者在第5天结束时出院的概率为0.88(95%可信区间：0.87,0.90)，而按照“从第3天开始进食”方案的患者出院的概率为0.64（95%可信区间：0.62,0.66）。在对时间相关的混杂因素进行调整后，这种差异的大部分消失了，统计方法也产生了类似的结果。TMLE提供了一种灵活的评估方法；因此，我们提供实用的实施指导，以鼓励更广泛地使用它。
Longitudinal data sources offer new opportunities for the evaluation of sequential interventions. To adjust for time-dependent confounding in these settings, longitudinal targeted maximum likelihood based estimation (TMLE), a doubly robust method that can be coupled with machine learning, has been proposed. This paper provides a tutorial in applying longitudinal TMLE, in contrast to inverse probability of treatment weighting and g-computation based on iterative conditional expectations. We apply these methods to estimate the causal effect of nutritional interventions on clinical outcomes among critically ill children in a United Kingdom study (Control of Hyperglycemia in Paediatric Intensive Care, 2008–2011). We estimate the probability of a child’s being discharged alive from the pediatric intensive care unit by a given day, under a range of static and dynamic feeding regimes. We find that before adjustment, patients who follow the static regime “never feed” are discharged by the end of the fifth day with a probability of 0.88 (95% confidence interval: 0.87, 0.90), while for the patients who follow the regime “feed from day 3,” the probability of discharge is 0.64 (95% confidence interval: 0.62, 0.66). After adjustment for time-dependent confounding, most of this difference disappears, and the statistical methods produce similar results. TMLE offers a flexible estimation approach; hence, we provide practical guidance on implementation to encourage its wider use.
登录
查看更多内容
DOI：
10.1146/annurev-statistics-022513-115553
发表时间：
2014
影响因子：
7.9
作者：
Chakraborty B;Murphy SA
通讯作者：
Murphy SA
影响因子：
1.2
作者：
Cain, Lauren E.;Robins, James M.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
3.4
作者：
Mehta, Nilesh M.;Compher, Charlene
通讯作者：
Compher, Charlene
影响因子：
5
作者：
Hernan, Miguel A.;Robins, James M.
通讯作者：
Robins, James M.
影响因子：
2
作者：
Brumback, BA;Hernán, MA;Robins, JM
通讯作者：
Robins, JM