Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard
Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard
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DOI：
10.1002/acr.22896
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发表时间：
2016-12-01
影响因子：
4.7
通讯作者：
Taylor, William J.
中科院分区：
文献类型：
--
作者：
Dalbeth, Nicola;Schumacher, H. Ralph;Taylor, William J.
Objective.从流行病学研究中常用的项目中确定痛风的最佳调查定义。痛风的调查定义是从34项流行病学研究中确定的，这些研究为全球尿酸遗传学联盟（GUGC）的全基因组关联研究做出了贡献。将来自更新的痛风分类标准研究（SUGAR）的数据随机分为开发和测试数据集。在开发数据集中使用逻辑回归形成数据驱动的病例定义。该定义，沿着GUGC研究中使用的定义和2015年美国流变学学院（ACR）/欧洲抗风湿联盟（EULAR）痛风分类标准应用于测试数据集，使用尿酸盐晶体鉴定作为金标准。对于所有测试的GUGC定义，简单的定义“自我报告的痛风或降尿酸治疗的使用”有最好的测试性能特征（敏感性82%，特异性72%）。简单定义与SUGAR数据驱动的病例定义具有相似的性能，具有5个加权项目：自我报告，医生诊断的自我报告，秋水仙碱使用，降尿酸治疗使用和高尿酸血症（敏感性87%，特异性70%）。这两个定义的表现优于1977年美国风湿协会调查标准（敏感性82%，特异性67%）。在所有测试的定义中，2015年ACR/EULAR标准具有最佳性能（灵敏度92%，特异性89%）。一个简单的定义“自我报告痛风或降尿酸治疗的使用”有最好的测试性能的特点，现有的定义，使用常规可用的数据。更复杂的特征组合更敏感，但仍然缺乏良好的特异性。如果特定研究需要更准确的病例定义，则应考虑2015年ACR/EULAR痛风分类标准。
Objective. To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies.Methods. Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard.Results. For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%).Conclusion. A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.