GRADE Guidelines 28: Use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks
GRADE Guidelines 28: Use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks
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DOI：
10.1016/j.jclinepi.2019.12.023
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发表时间：
2020-05-01
影响因子：
7.2
通讯作者：
Iorio, Alfonso
中科院分区：
文献类型：
--
作者：
Foroutan, Farid;Guyatt, Gordon;Iorio, Alfonso
目的：本研究的目的是提供使用建议评估、发展和评价分级（GRADE）方法的指导，以确定预后因素和未来结局之间相关性估计的确定性。研究设计和设置：我们通过一个迭代过程制定了我们的指南，该过程涉及对已发表的系统评价和预后因素的荟萃分析的审查，与成员的协商，反馈，陈述和GRADE工作组会议上的讨论。结果如下：对于预后问题，大量的观察证据（可能包括随机对照试验中招募的患者）开始时具有高度的确定性。GRADE中用于降低证据确定性的五个领域，即偏倚风险、不精确性、不一致性、间接性和发表偏倚，以及用于提高证据确定性的五个领域，也适用于评估预后因素与结局之间的关联。应确定他们的评级是否考虑（非情境化）或考虑（情境化）临床背景，因为这可能导致对证据确定性的可变判断。结论：GRADE为解决治疗和总体预后的证据提出的相同原则在评估个体预后因素时效果良好，无论是在非情境化还是情境化环境中。(C)2020爱思唯尔公司All rights reserved.
Objective: The objective of this study was to provide guidance on the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine certainty in estimates of association between prognostic factors and future outcomes. Study Design and Setting: We developed our guidance through an iterative process that involved review of published systematic reviews and meta-analyses of prognostic factors, consultation with members, feedback, presentation, and discussion at the GRADE Working Group meetings. Results: For questions of prognosis, a body of observational evidence (potentially including patients enrolled in randomized controlled trials) begins as high certainty in the evidence. The five domains of GRADE for rating down certainty in the evidence, that is, risk of bias, imprecision, inconsistency, indirectness, and publication bias, as well as the domains for rating up, also apply to estimates of associations between prognostic factors and outcomes. One should determine if their ratings do not consider (noncontextualized) or consider (contextualized) the clinical context as this will may result in variable judgments on certainty of the evidence. Conclusions: The same principles GRADE proposed for bodies of evidence addressing treatment and overall prognosis work well in assessing individual prognostic factors, both in noncontextualized and contextualized settings. (C) 2020 Elsevier Inc. All rights reserved.