Pang Chun Lap, Pilkington Nicola, Wei Yinghui, Peters Jaime, Roobottom Carl, Hyde Chris
University of Plymouth, Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Tamar Science Park, Research Way, Plymouth, PL6 8BU, UK.
Plymouth Hospitals NHS Trust, Derriford Hospital, Imaging Department, Derriford Rd, Plymouth, PL6 8DH, UK.
BMC Cardiovasc Disord. 2018 Feb 21;18(1):39. doi: 10.1186/s12872-018-0777-5.
Computed tomography (CT) biomarkers claim to improve cardiovascular risk stratification. This review focuses on significant differences in incremental measures between adequate and inadequate reporting practise.
Studies included were those that used Framingham Risk Score as a baseline and described the incremental value of adding calcium score or CT coronary angiogram in predicting cardiovascular risk. Searches of MEDLINE, EMBASE, Web of Science and Cochrane Central were performed with no language restriction.
Thirty five studies consisting of 206,663 patients (men = 118,114, 55.1%) were included. The baseline Framingham Risk Score included the 1998, 2002 and 2008 iterations. Selective reporting, inconsistent reference groupings and thresholds were found. Twelve studies (34.3%) had major and 23 (65.7%) had minor alterations and the respective Δ AUC were significantly different (p = 0.015). When the baseline model performed well, the Δ AUC was relatively lower with the addition of a CT biomarker (Spearman coefficient = - 0.46, p < 0.0001; n = 33; 76 pairs of data). Other factors that influenced AUC performance included exploration of data analysis, calibration, validation, multivariable and AUC documentation (all p < 0.05). Most studies (68.7%) that reported categorical NRI (n = 16; 46 pairs of data) subjectively drew strong conclusions along with other poor reporting practices. However, no significant difference in values of NRI was found between adequate and inadequate reporting.
The widespread practice of poor reporting particularly association, discrimination, reclassification, calibration and validation undermines the claimed incremental value of CT biomarkers over the Framingham Risk Score alone. Inadequate reporting of discrimination inflates effect estimate, however, that is not necessarily the case for reclassification.
计算机断层扫描（CT）生物标志物据称可改善心血管风险分层。本综述重点关注充分报告与不充分报告实践中增量测量的显著差异。
纳入的研究是以弗雷明汉风险评分作为基线，并描述添加钙评分或CT冠状动脉造影在预测心血管风险方面的增量价值的研究。对MEDLINE、EMBASE、科学网和考克兰中心进行了检索，无语言限制。
纳入了35项研究，共206,663名患者（男性 = 118,114名，占55.1%）。基线弗雷明汉风险评分包括1998年、2002年和2008年的版本。发现了选择性报告、不一致的参考分组和阈值。12项研究（34.3%）有重大改变，23项（65.7%）有微小改变，各自的ΔAUC有显著差异（p = 0.015）。当基线模型表现良好时，添加CT生物标志物后的ΔAUC相对较低（斯皮尔曼系数 = -0.46，p < 0.0001；n = 33；76对数据）。影响AUC表现的其他因素包括数据分析的探索、校准、验证、多变量和AUC记录（均p < 0.05）。大多数报告分类净重新分类指数（n = 16；46对数据）的研究主观地得出了强有力的结论以及其他不良报告做法。然而，充分报告与不充分报告之间的净重新分类指数值没有显著差异。
广泛存在的不良报告做法，特别是关联、区分、重新分类、校准和验证方面的做法，削弱了CT生物标志物相对于仅使用弗雷明汉风险评分所宣称的增量价值。区分报告不充分会夸大效应估计，但重新分类情况不一定如此。
