利用量子回归从 IPD 元分析中估算参考区间。

IF 3.9 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES BMC Medical Research Methodology Pub Date : 2024-10-26 DOI:10.1186/s12874-024-02378-0
Ziren Jiang, Haitao Chu, Zhen Wang, M Hassan Murad, Lianne K Siegel
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引用次数: 0

摘要

背景:参考区间是指健康人群中某一特定比例的测量值预计落在其中的区间,常用于医疗实践中。通过荟萃分析综合多项研究的信息,可以提供比单项研究更精确、更有代表性的参考区间。然而,目前从荟萃分析中估算参考区间的方法主要依赖于总体数据,并且需要参数分布假设,而这些假设并非总能得到验证:方法:有了个体参与者数据(IPD),就可以使用非参数方法估算参考区间,而无需任何分布假设。此外,还可以引入患者层面的协变量来估计个性化的参考区间,这样可能更适用于特定患者。本文介绍了一种量子回归方法,用于估计固定效应模型下 IPD 元分析的参考区间:我们通过模拟研究比较了几种非参数引导方法,以考虑研究内部的相关性。在固定效应模型下,我们建议将研究固定下来,只在每个研究中随机抽样替换受试者:我们建议在 IPD 元分析中使用量化回归来估计参考区间。根据模拟结果,我们确定了估算参考区间不确定性的最佳引导策略。肝脏僵硬度测量是一种临床上重要的诊断测试,在儿童中没有明确的参考范围,本研究以肝僵硬度测量为例,展示了量化回归在估计总体和特定受试者参考区间中的应用。
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Estimating reference intervals from an IPD meta-analysis using quantile regression.

Background: Reference intervals, which define an interval in which a specific proportion of measurements from a healthy population are expected to fall, are commonly used in medical practice. Synthesizing information from multiple studies through meta-analysis can provide a more precise and representative reference interval than one derived from a single study. However, the current approaches for estimating the reference interval from a meta-analysis mainly rely on aggregate data and require parametric distributional assumptions that cannot always be checked.

Methods: With the availability of individual participant data (IPD), non-parametric methods can be used to estimate reference intervals without any distributional assumptions. Furthermore, patient-level covariates can be introduced to estimate personalized reference intervals that may be more applicable to specific patients. This paper introduces quantile regression as a method to estimate the reference interval from an IPD meta-analysis under the fixed effects model.

Results: We compared several non-parametric bootstrap methods through simulation studies to account for within-study correlation. Under fixed effects model, we recommend keeping the studies fixed and only randomly sampling subjects with replacement within each study.

Conclusion: We proposed to use the quantile regression in the IPD meta-analysis to estimate the reference interval. Based on the simulation results, we identify an optimal bootstrap strategy for estimating the uncertainty of the estimated reference interval. An example of liver stiffness measurements, a clinically important diagnostic test without explicitly established reference range in children, is provided to demonstrate the use of quantile regression in estimating both overall and subject-specific reference intervals.

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来源期刊
BMC Medical Research Methodology
BMC Medical Research Methodology 医学-卫生保健
CiteScore
6.50
自引率
2.50%
发文量
298
审稿时长
3-8 weeks
期刊介绍: BMC Medical Research Methodology is an open access journal publishing original peer-reviewed research articles in methodological approaches to healthcare research. Articles on the methodology of epidemiological research, clinical trials and meta-analysis/systematic review are particularly encouraged, as are empirical studies of the associations between choice of methodology and study outcomes. BMC Medical Research Methodology does not aim to publish articles describing scientific methods or techniques: these should be directed to the BMC journal covering the relevant biomedical subject area.
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