Personalized risk-based screening for diabetic retinopathy: A multivariate approach versus the use of stratification rules.
Personalized risk-based screening for diabetic retinopathy: A multivariate approach versus the use of stratification rules.
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基于个性化风险的糖尿病性视网膜筛查：一种多元方法与使用分层规则的使用。
DOI：
10.1111/dom.13552
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Harding SP
中科院分区：
文献类型：
--
作者：
García-Fiñana M;Hughes DM;Cheyne CP;Broadbent DM;Wang A;Komárek A;Stratton IM;Mobayen-Rahni M;Alshukri A;Vora JP;Harding SP
评估我们提出的多变量方法，以确定在1年的筛查间隔内将发展为威胁视力的糖尿病视网膜病变（STDR）的患者，并探讨简单分层规则对预测的影响。采用一种新颖的多变量纵向判别方法分析了糖尿病患者（PWD） 7年数据集（2009 - 2016）。糖尿病视网膜病变的水平，通过对双眼的常规数字筛查照片进行评估，并利用长期收集的临床数据进行联合建模。采用基于视网膜病变水平的简单分层规则，并与多变量判别法进行比较。分析了13 103例PWD（49 520次筛查）的数据。多变量方法准确预测了84.0%的患者在预测后1年内是否发生STDR(95%置信区间[CI] 80.4 ~ 89.7)，而两种分层规则分别为56.7% （95% CI 55.5 ~ 58.0）和79.7% （95% CI 78.8 ~ 80.6）。虽然分层规则检测到高达95.2% （95% CI 92.2‐97.6）的STDR病例（敏感性），但只有55.6% （95% CI 54.5‐56.7）的未发生STDR的患者被正确识别（特异性），而多变量风险模型分别为85.4% （95% CI 80.4‐89.7%）和84.0% （95% CI 80.7‐87.6%）。使用多变量风险模型可以准确预测PWD进展为STDR，同时保持理想的特异性。虽然简单的分层规则可以达到良好的灵敏度水平，但目前的研究表明，其较低的特异性（高假阳性率）因此需要更频繁的眼科检查。
To evaluate our proposed multivariate approach to identify patients who will develop sight‐threatening diabetic retinopathy (STDR) within a 1‐year screen interval, and explore the impact of simple stratification rules on prediction. A 7‐year dataset (2009‐2016) from people with diabetes (PWD) was analysed using a novel multivariate longitudinal discriminant approach. Level of diabetic retinopathy, assessed from routine digital screening photographs of both eyes, was jointly modelled using clinical data collected over time. Simple stratification rules based on retinopathy level were also applied and compared with the multivariate discriminant approach. Data from 13 103 PWD (49 520 screening episodes) were analysed. The multivariate approach accurately predicted whether patients developed STDR or not within 1 year from the time of prediction in 84.0% of patients (95% confidence interval [CI] 80.4‐89.7), compared with 56.7% (95% CI 55.5‐58.0) and 79.7% (95% CI 78.8‐80.6) achieved by the two stratification rules. While the stratification rules detected up to 95.2% (95% CI 92.2‐97.6) of the STDR cases (sensitivity) only 55.6% (95% CI 54.5‐56.7) of patients who did not develop STDR were correctly identified (specificity), compared with 85.4% (95% CI 80.4‐89.7%) and 84.0% (95% CI 80.7‐87.6%), respectively, achieved by the multivariate risk model. Accurate prediction of progression to STDR in PWD can be achieved using a multivariate risk model whilst also maintaining desirable specificity. While simple stratification rules can achieve good levels of sensitivity, the present study indicates that their lower specificity (high false‐positive rate) would therefore necessitate a greater frequency of eye examinations.
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