Joint modeling of two longitudinal outcomes and competing risk data
Joint modeling of two longitudinal outcomes and competing risk data
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DOI：
10.1002/sim.6158
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发表时间：
2014-08-15
影响因子：
2
通讯作者：
Lesaffre, Emmanuel
中科院分区：
文献类型：
--
作者：
Andrinopoulou, Eleni-Rosalina;Rizopoulos, Dimitris;Lesaffre, Emmanuel
主动脉瓣压差和主动脉瓣返流是主动脉瓣功能的超声心动图标志。两者都是在瓣膜异常患者中重复测量的生物标志物，因此，预期它们具有生物学相关性。失访可能由多种原因引起，包括瓣膜进展相关，例如介入治疗甚至患者死亡。在这种情况下，共同分析这些结果将是有益和适当的。关节模型近年来受到广泛关注，因为它们涵盖了广泛的临床应用，并具有良好的效果。我们提出了一个联合模型，包括两个纵向结果，一个连续（主动脉瓣压差）和一个顺序（主动脉瓣返流），以及两个事件发生时间（死亡和再次手术）。此外，我们允许更多的灵活性的平均演变和主题的特定配置文件的连续重复的结果，通过使用B-样条。然而，一个缺点是，当模型采用非线性结构时，我们在解释结果时可能会遇到困难。为了克服这个问题，我们提出了一个图形化的方法。在本文中，我们应用贝叶斯框架下提出的联合模型，使用的数据集，包括一系列超声心动图测量主动脉瓣压差和主动脉瓣返流和测量的发生死亡和再次手术的患者谁收到了人体组织瓣膜的主动脉位置。将讨论结果的解释。版权所有（C）2014 JohnWiley & Sons，Ltd.
Aortic gradient and aortic regurgitation are echocardiographic markers of aortic valve function. Both are biomarkers repeatedly measured in patients with valve abnormalities, and thus, it is expected that they are biologically interrelated. Loss of follow-up could be caused by multiple reasons, including valve progression related, such as an intervention or even the death of the patient. In that case, it would be of interest and appropriate to analyze these outcomes jointly. Joint models have recently received much attention because they cover a wide range of clinical applications and have promising results. We propose a joint model consisting of two longitudinal outcomes, one continuous (aortic gradient) and one ordinal (aortic regurgitation), and two time-to-events (death and reoperation). Moreover, we allow for more flexibility for the average evolution and the subject-specific profiles of the continuous repeated outcome by using B-splines. A disadvantage, however, is that when adopting a non-linear structure for the model, we may have difficulties when interpreting the results. To overcome this problem, we propose a graphical approach. In this paper, we apply the proposed joint models under the Bayesian framework, using a data set including serial echocardiographic measurements of aortic gradient and aortic regurgitation and measurements of the occurrence of death and reoperation in patients who received a human tissue valve in the aortic position. The interpretation of the results will be discussed. Copyright (C) 2014 JohnWiley & Sons, Ltd.