Joint synthesis of conditionally related multiple outcomes makes better use of data than separate meta-analyses.
Joint synthesis of conditionally related multiple outcomes makes better use of data than separate meta-analyses.
复制标题
与单独的荟萃分析相比，条件相关的多个结果的联合综合可以更好地利用数据。
DOI：
10.1002/jrsm.1380
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发表时间：
2020
影响因子：
9.8
通讯作者：
Anwer S
中科院分区：
文献类型：
--
作者：
Anwer S
背景当不同试验中报告的结果之间存在结构关系时，对每个结果的单独分析不能提供决策所需的单一的连贯分析。例如，产期抗菌预防(IAP)预防早发性B组链球菌(EOGBS)疾病的试验可以报告三种治疗效果：对新生儿细菌定植的影响，对EOGBS的影响，以及对EOGBS的影响，条件是新生儿定植。这些结果是条件相关的，或嵌套在多态模型中。本文展示了如何利用这些结构关系，提供所有可用数据的单一连贯合成，同时检查以确保不同证据来源的一致性。结果总的来说，IAP的使用降低了EOGBS的风险(RR：0.03；95%可信区间(CRI)：0.002-0.13)。大多数治疗效果是由于防止了被殖民母亲的新生儿的定居(RR：0.08，95%CRI：0.04-0.14)。结节分割显示，仅用直接证据计算的治疗效果与根据剩余证据预测的治疗效果一致(p=0.15)。这一发现与之前发表的不同结果的单独荟萃分析一致，一旦正确地重新分析了这些结果，就没有细胞。结论在可能的情况下，应该将多个结果综合在一起，考虑到它们的结构关系。这产生了一种内部连贯的分析，适合于决策，其中对每一种治疗效果的估计是基于所有可用的证据(直接和间接)。对每个结果的单独荟萃分析没有这些属性。
BackgroundWhen there are structural relationships between outcomes reported in different trials, separate analyses of each outcome do not provide a single coherent analysis, which is required for decision‐making. For example, trials of intrapartum anti‐bacterial prophylaxis (IAP) to prevent early onset group B streptococcal (EOGBS) disease can report three treatment effects: the effect on bacterial colonisation of the newborn, the effect on EOGBS, and the effect on EOGBS conditional on newborn colonisation. These outcomes are conditionally related, or nested, in a multi‐state model.This paper shows how to exploit these structural relationships, providing a single coherent synthesis of all the available data, while checking to ensure that different sources of evidence are consistent.ResultsOverall, the use of IAP reduces the risk of EOGBS (RR: 0.03; 95% Credible Interval (CrI): 0.002–0.13). Most of the treatment effect is due to the prevention of colonisation in newborns of colonised mothers (RR: 0.08, 95% CrI: 0.04–0.14). Node‐splitting demonstrated that the treatment effect calculated using only direct evidence was consistent with that predicted from the remaining evidence (p= 0.15). The findings accorded with previously published separate meta‐analyses of the different outcomes, once these are re‐analysed correctly accounting for zero cells.ConclusionMultiple outcomes should be synthesised together where possible, taking account of their structural relationships. This generates an internally coherent analysis, suitable for decision making, in which estimates of each of the treatment effects are based on all available evidence (direct and indirect). Separate meta‐analyses of each outcome have none of these properties.