School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Ann Emerg Med. 2022 Jul;80(1):12-19. doi: 10.1016/j.annemergmed.2022.01.046. Epub 2022 Mar 24.
Composite outcomes are widely used in clinical research. Existing literature has considered the pros and cons of composite outcomes in clinical trials, but their extensive use in clinical prediction has received much less attention. Clinical prediction assists decision-making by directing patients with higher risks of adverse outcomes toward interventions that provide the greatest benefits to those at the greatest risk. In this article, we summarize our existing understanding of the advantages and disadvantages of composite outcomes, consider how these relate to clinical prediction, and highlight the problem of key predictors having markedly different associations with individual components of the composite outcome. We suggest that a "composite outcome fallacy" may occur when a clinical prediction model is based on strong associations between key predictors and one component of a composite outcome (such as mortality) and used to direct patients toward intervention when these predictors actually have an inverse association with a more relevant component of the composite outcome (such as the use of a lifesaving intervention). We propose that clinical prediction scores using composite outcomes should report their accuracy for key components of the composite outcome and examine for inconsistencies among predictor variables.
复合结局广泛应用于临床研究。现有文献已经考虑了临床试验中复合结局的优缺点，但它们在临床预测中的广泛应用却受到了较少关注。临床预测通过指导具有更高不良结局风险的患者采取干预措施，为处于最大风险的患者提供最大的益处，从而辅助决策。在本文中，我们总结了对复合结局的优缺点的现有认识，考虑了这些与临床预测的关系，并强调了关键预测因子与复合结局的各个组成部分之间具有明显不同关联的问题。我们认为，当临床预测模型基于关键预测因子与复合结局的一个组成部分（如死亡率）之间的强关联，并在这些预测因子实际上与复合结局的更相关组成部分（如救生干预措施的使用）之间存在反比关联时，可能会出现“复合结局谬误”。我们建议，使用复合结局的临床预测评分应报告其对复合结局关键组成部分的准确性，并检查预测变量之间的不一致性。
