论文标题
临床预测模型以预测多种二元结果的风险:方法比较
Clinical Prediction Models to Predict the Risk of Multiple Binary Outcomes: a comparison of approaches
论文作者
论文摘要
临床预测模型(CPM)用于预测临床相关的结果或事件。通常,预后CPM被得出以预测单一未来结果的风险。但是,随着对多种多元车的预测的重视不断增加,CPM越来越需要同时预测未来多种结果的风险。多结果风险预测的一种常见方法是分别为每个结果得出CPM,然后乘以预测的风险。仅当结果在有条件地独立的情况下,这种方法才有效,并且由于协变量是独立的,并且无法利用结果之间的潜在关系。本文概述了几种可用于开发多个结果的预后CPM的方法。我们考虑四种方法,范围为复杂性和假定的条件独立性假设:即概率分类器链,多项式逻辑回归,多元逻辑回归和贝叶斯概率模型。将这些与依赖条件独立性的方法进行了比较:单独的单变量CPM和堆叠回归。我们通过模拟III数据库采用仿真研究和现实世界的示例,我们说明,仅使用对结果之间的残留相关性进行模拟的方法来得出多种结果的联合风险预测的CPM。在这种情况下,我们的结果表明概率分类链,多项式逻辑回归或贝叶斯概率模型都是适当的选择。当多个相关或与结构相关的结果引起人们的关注并建议更全面的风险预测时,我们质疑每个结果的CPM的开发。
Clinical prediction models (CPMs) are used to predict clinically relevant outcomes or events. Typically, prognostic CPMs are derived to predict the risk of a single future outcome. However, with rising emphasis on the prediction of multi-morbidity, there is growing need for CPMs to simultaneously predict risks for each of multiple future outcomes. A common approach to multi-outcome risk prediction is to derive a CPM for each outcome separately, then multiply the predicted risks. This approach is only valid if the outcomes are conditionally independent given the covariates, and it fails to exploit the potential relationships between the outcomes. This paper outlines several approaches that could be used to develop prognostic CPMs for multiple outcomes. We consider four methods, ranging in complexity and assumed conditional independence assumptions: namely, probabilistic classifier chain, multinomial logistic regression, multivariate logistic regression, and a Bayesian probit model. These are compared with methods that rely on conditional independence: separate univariate CPMs and stacked regression. Employing a simulation study and real-world example via the MIMIC-III database, we illustrate that CPMs for joint risk prediction of multiple outcomes should only be derived using methods that model the residual correlation between outcomes. In such a situation, our results suggest that probabilistic classification chains, multinomial logistic regression or the Bayesian probit model are all appropriate choices. We call into question the development of CPMs for each outcome in isolation when multiple correlated or structurally related outcomes are of interest and recommend more holistic risk prediction.