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A multiple‐model generalisation of updating clinical prediction models

机译:更新临床预测模型的多模型概括

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摘要

There is growing interest in developing clinical prediction models (CPMs) to aid local healthcare decision‐making. Frequently, these CPMs are developed in isolation across different populations, with repetitive de novo derivation a common modelling strategy. However, this fails to utilise all available information and does not respond to changes in health processes through time and space. Alternatively, model updating techniques have previously been proposed that adjust an existing CPM to suit the new population, but these techniques are restricted to a single model. Therefore, we aimed to develop a generalised method for updating and aggregating multiple CPMs. The proposed “hybrid method” re‐calibrates multiple CPMs using stacked regression while concurrently revising specific covariates using individual participant data (IPD) under a penalised likelihood. The performance of the hybrid method was compared with existing methods in a clinical example of mortality risk prediction after transcatheter aortic valve implantation, and in 2 simulation studies. The simulation studies explored the effect of sample size and between‐population‐heterogeneity on the method, with each representing a situation of having multiple distinct CPMs and 1 set of IPD. When the sample size of the IPD was small, stacked regression and the hybrid method had comparable but highest performance across modelling methods. Conversely, in large IPD samples, development of a new model and the hybrid method gave the highest performance. Hence, the proposed strategy can inform the choice between utilising existing CPMs or developing a model de novo, thereby incorporating IPD, existing research, and prior (clinical) knowledge into the modelling strategy.
机译:开发临床预测模型(CPM)以帮助当地医疗保健决策的兴趣日益浓厚。通常,这些CPM是在不同的人群中孤立地开发的,重复的从头推导是一种常见的建模策略。但是,这无法利用所有可用信息,也无法响应健康过程在时间和空间上的变化。替代地,先前已经提出了模型更新技术,其调整现有的CPM以适应新的人群,但是这些技术限于单个模型。因此,我们旨在开发一种用于更新和汇总多个CPM的通用方法。提出的“混合方法”使用堆叠回归重新校准多个CPM,同时使用单个参与者数据(IPD)修改特定协变量,同时降低了可能性。在经导管主动脉瓣植入术后死亡风险预测的临床实例中,以及在2个模拟研究中,将混合方法的性能与现有方法进行了比较。模拟研究探索了样本量和种群间异质性对该方法的影响,每种方法都代表具有多个不同的CPM和一组IPD的情况。当IPD的样本量较小时,堆叠回归和混合方法在各个建模方法中具有可比但最高的性能。相反,在大型IPD样本中,开发新模型和混合方法可提供最高的性能。因此,所提出的策略可以为利用现有CPM或重新开发模型之间的选择提供依据,从而将IPD,现有研究和现有(临床)知识纳入建模策略。

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