Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding.
Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding.
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DOI：
10.1097/hjh.0000000000002706
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发表时间：
2021-04-01
影响因子：
4.9
通讯作者：
South AM
中科院分区：
文献类型：
--
作者：
Cohen JB;D'Agostino McGowan L;Jensen ET;Rigdon J;South AM
在COVID-19期间使用ACE抑制剂或ARB治疗高血压的担忧仍未得到解决。尽管使用更稳健方法的研究提供了一些清晰度，但偏见的来源仍然存在，快速解决这个问题仍然至关重要。在这篇综述中，我们讨论了有害的来源的偏见，使用因果模型框架，包括随时间变化的混杂因素，碰撞，信息和时间依赖性的偏见，在最近发表的研究的背景下。我们讨论了因果推理方法，可以解决这些问题，包括因果图，时间到事件的分析，敏感性分析和边际结构建模。我们讨论了影响修改，我们提出了因果调解分析的作用，估计间接影响，通过调解因素，特别是组分的肾素-血管紧张素系统。在评价观察性研究时，彻底了解这些偏倚来源以及解决这些偏倚的适当方法至关重要，以便为患者管理决策提供关于ACE抑制剂或ARB是否与COVID-19风险更大相关的信息。
Concerns over ACE inhibitor or ARB use to treat hypertension during COVID-19 remain unresolved. Although studies using more robust methodologies provided some clarity, sources of bias persist and it remains critical to quickly address this question. In this review, we discuss pernicious sources of bias using a causal model framework, including time-varying confounder, collider, information, and time-dependent bias, in the context of recently published studies. We discuss causal inference methodologies that can address these issues, including causal diagrams, time-to-event analyses, sensitivity analyses, and marginal structural modeling. We discuss effect modification and we propose a role for causal mediation analysis to estimate indirect effects via mediating factors, especially components of the renin–angiotensin system. Thorough knowledge of these sources of bias and the appropriate methodologies to address them is crucial when evaluating observational studies to inform patient management decisions regarding whether ACE inhibitors or ARBs are associated with greater risk from COVID-19.