Ren Yan, Huang Shiyao, Li Qianrui, Liu Chunrong, Li Ling, Tan Jing, Zou Kang, Sun Xin
Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
BMJ Open. 2021 Feb 5;11(2):e042435. doi: 10.1136/bmjopen-2020-042435.
Our study aimed to systematically review the methodological characteristics of studies that identified prognostic factors or developed or validated models for predicting mortalities among patients with acute aortic dissection (AAD), which would inform future work.
DESIGN/SETTING: A methodological review of published studies.
We searched PubMed and EMBASE from inception to June 2020 for studies about prognostic factors or prediction models on mortality among patients with AAD. Two reviewers independently collected the information about methodological characteristics. We also documented the information about the performance of the prognostic factors or prediction models.
Thirty-two studies were included, of which 18 evaluated the performance of prognostic factors, and 14 developed or validated prediction models. Of the 32 studies, 23 (72%) were single-centre studies, 22 (69%) used data from electronic medical records, 19 (59%) chose retrospective cohort study design, 26 (81%) did not report missing predictor data and 5 (16%) that reported missing predictor data used complete-case analysis. Among the 14 prediction model studies, only 3 (21%) had the event per variable over 20, and only 5 (36%) reported both discrimination and calibration statistics. Among model development studies, 3 (27%) did not report statistical methods, 3 (27%) exclusively used statistical significance threshold for selecting predictors and 7 (64%) did not report the methods for handling continuous predictors. Most prediction models were considered at high risk of bias. The performance of prognostic factors showed varying discrimination (AUC 0.58 to 0.95), and the performance of prediction models also varied substantially (AUC 0.49 to 0.91). Only six studies reported calibration statistic.
The methods used for prognostic studies on mortality among patients with AAD-including prediction models or prognostic factor studies-were suboptimal, and the model performance highly varied. Substantial efforts are warranted to improve the use of the methods in this population.
我们的研究旨在系统评价那些确定急性主动脉夹层（AAD）患者预后因素或开发或验证死亡率预测模型的研究的方法学特征，为未来的研究提供参考。
设计/背景：对已发表研究进行方法学综述。
我们检索了从创刊至2020年6月的PubMed和EMBASE数据库，查找关于AAD患者死亡率的预后因素或预测模型的研究。两名研究者独立收集有关方法学特征的信息。我们还记录了预后因素或预测模型的性能信息。
纳入32项研究，其中18项评估了预后因素的性能，14项开发或验证了预测模型。在这32项研究中，23项（72%）为单中心研究，22项（69%）使用电子病历数据，19项（59%）选择回顾性队列研究设计，26项（81%）未报告预测变量数据缺失情况，5项（16%）报告了预测变量数据缺失情况的研究采用了完整病例分析。在14项预测模型研究中，只有3项（21%）每个变量的事件数超过20，只有5项（36%）报告了区分度和校准统计量。在模型开发研究中，3项（27%）未报告统计方法，3项（27%）仅使用统计学显著性阈值来选择预测变量，7项（64%）未报告处理连续预测变量的方法。大多数预测模型被认为存在较高的偏倚风险。预后因素的性能显示出不同的区分度（AUC为0.58至0.95），预测模型的性能也有很大差异（AUC为0.49至0.91）。只有六项研究报告了校准统计量。
用于AAD患者死亡率预后研究的方法——包括预测模型或预后因素研究——并不理想，模型性能差异很大。需要付出巨大努力来改进该人群中这些方法的应用。
