scholarly journals A systematic review of risk prediction models for perioperative mortality after thoracic surgery

2020 ◽  
Author(s):  
Marcus Taylor ◽  
Syed F Hashmi ◽  
Glen P Martin ◽  
Michael Shackcloth ◽  
Rajesh Shah ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Risk Prediction ◽  
Prediction Models ◽  
Assessment Tool ◽  
Model Performance ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Perioperative Mortality ◽  
Risk Prediction Models ◽  
Multiple Risk

Abstract OBJECTIVES Guidelines advocate that patients being considered for thoracic surgery should undergo a comprehensive preoperative risk assessment. Multiple risk prediction models to estimate the risk of mortality after thoracic surgery have been developed, but their quality and performance has not been reviewed in a systematic way. The objective was to systematically review these models and critically appraise their performance. METHODS The Cochrane Library and the MEDLINE database were searched for articles published between 1990 and 2019. Studies that developed or validated a model predicting perioperative mortality after thoracic surgery were included. Data were extracted based on the checklist for critical appraisal and data extraction for systematic reviews of prediction modelling studies. RESULTS A total of 31 studies describing 22 different risk prediction models were identified. There were 20 models developed specifically for thoracic surgery with two developed in other surgical specialties. A total of 57 different predictors were included across the identified models. Age, sex and pneumonectomy were the most frequently included predictors in 19, 13 and 11 models, respectively. Model performance based on either discrimination or calibration was inadequate for all externally validated models. The most recent data included in validation studies were from 2018. Risk of bias (assessed using Prediction model Risk Of Bias ASsessment Tool) was high for all except two models. CONCLUSIONS Despite multiple risk prediction models being developed to predict perioperative mortality after thoracic surgery, none could be described as appropriate for contemporary thoracic surgery. Contemporary validation of available models or new model development is required to ensure that appropriate estimates of operative risk are available for contemporary thoracic surgical practice.

scholarly journals Can risk be predicted? An umbrella systematic review of current risk prediction models for cardiovascular diseases, diabetes and hypertension

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030234 ◽  
Author(s):  
Francesca Lucaroni ◽  
Domenico Cicciarella Modica ◽  
Mattia Macino ◽  
Leonardo Palombi ◽  
Alessio Abbondanzieri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Diseases ◽  
Risk Prediction ◽  
Prediction Models ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Risk Prediction Models

ObjectiveTo provide an overview of the currently available risk prediction models (RPMs) for cardiovascular diseases (CVDs), diabetes and hypertension, and to compare their effectiveness in proper recognition of patients at risk of developing these diseases.DesignUmbrella systematic review.Data sourcesPubMed, Scopus, Cochrane Library.Eligibility criteriaSystematic reviews or meta-analysis examining and comparing performances of RPMs for CVDs, hypertension or diabetes in healthy adult (18–65 years old) population, published in English language.Data extraction and synthesisData were extracted according to the following parameters: number of studies included, intervention (RPMs applied/assessed), comparison, performance, validation and outcomes. A narrative synthesis was performed. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Study selection3612 studies were identified. After title/abstract screening and removal of duplicate articles, 37 studies met the eligibility criteria. After reading the full text, 13 were deemed relevant for inclusion. Three further papers from the reference lists of these articles were then added.Study appraisalThe methodological quality of the included studies was assessed using the AMSTAR tool.Risk of bias in individual studiesRisk of Bias evaluation was carried out using the ROBIS tool.ResultsSixteen studies met the inclusion criteria: six focused on diabetes, two on hypertension and eight on CVDs. Globally, prediction models for diabetes and hypertension showed no significant difference in effectiveness. Conversely, some promising differences among prediction tools were highlighted for CVDs. The Ankle-Brachial Index, in association with the Framingham tool, and QRISK scores provided some evidence of a certain superiority compared with Framingham alone.LimitationsDue to the significant heterogeneity of the studies, it was not possible to perform a meta-analysis. The electronic search was limited to studies in English and to three major international databases (MEDLINE/PubMed, Scopus and Cochrane Library), with additional works derived from the reference list of other studies; grey literature with unpublished documents was not included in the search. Furthermore, no assessment of potential adverse effects of RPMs was carried out.ConclusionsConsistent evidence is available only for CVD prediction: the Framingham score, alone or in combination with the Ankle-Brachial Index, and the QRISK score can be confirmed as the gold standard. Further efforts should not be concentrated on creating new scores, but rather on performing external validation of the existing ones, in particular on high-risk groups. Benefits could be further improved by supplementing existing models with information on lifestyle, personal habits, family and employment history, social network relationships, income and education.PROSPERO registration numberCRD42018088012.

scholarly journals Risk Prediction Model for Esophageal Cancer Among General Population: A Systematic Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Ru Chen ◽  
Rongshou Zheng ◽  
Jiachen Zhou ◽  
Minjuan Li ◽  
Dantong Shao ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prediction Model ◽  
Risk Prediction ◽  
Prediction Models ◽  
Precancerous Lesions ◽  
Gastrointestinal Symptoms ◽  
Risk Of Bias ◽  
Risk Prediction Model ◽  
Cochrane Library ◽  
Risk Prediction Models

Objective: The risk prediction model is an effective tool for risk stratification and is expected to play an important role in the early detection and prevention of esophageal cancer. This study sought to summarize the available evidence of esophageal cancer risk predictions models and provide references for their development, validation, and application.Methods: We searched PubMed, EMBASE, and Cochrane Library databases for original articles published in English up to October 22, 2021. Studies that developed or validated a risk prediction model of esophageal cancer and its precancerous lesions were included. Two reviewers independently extracted study characteristics including predictors, model performance and methodology, and assessed risk of bias and applicability with PROBAST (Prediction model Risk Of Bias Assessment Tool).Results: A total of 20 studies including 30 original models were identified. The median area under the receiver operating characteristic curve of risk prediction models was 0.78, ranging from 0.68 to 0.94. Age, smoking, body mass index, sex, upper gastrointestinal symptoms, and family history were the most commonly included predictors. None of the models were assessed as low risk of bias based on PROBST. The major methodological deficiencies were inappropriate date sources, inconsistent definition of predictors and outcomes, and the insufficient number of participants with the outcome.Conclusions: This study systematically reviewed available evidence on risk prediction models for esophageal cancer in general populations. The findings indicate a high risk of bias due to several methodological pitfalls in model development and validation, which limit their application in practice.

scholarly journals Risk prediction models for atherosclerotic cardiovascular disease: A systematic assessment with particular reference to Qatar

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Aziz Sheikh ◽  
Ulugbek Nurmatov ◽  
Huda Amer Al-Katheeri ◽  
Rasmeh Ali Al Huneiti
Keyword(s):  
Risk Prediction ◽  
Prediction Models ◽  
Ethnically Diverse ◽  
Risk Of Bias ◽  
Low Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Eligibility Criteria ◽  
Risk Prediction Models ◽  
Ascvd Risk

Background: Atherosclerotic cardiovascular disease (ASCVD) is a common disease in the State of Qatar and results in considerable morbidity, impairment of quality of life and mortality. The American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) is currently used in Qatar to identify those at high risk of ASCVD. However, it is unclear if this is the optimal ASCVD risk prediction model for use in Qatar's ethnically diverse population. Aims: This systematic review aimed to identify, assess the methodological quality of and compare the properties of established ASCVD risk prediction models for the Qatari population. Methods: Two reviewers performed head-to-head comparisons of established ASCVD risk calculators systematically. Studies were independently screened according to predefined eligibility criteria and critically appraised using Prediction Model Risk Of Bias Assessment Tool. Data were descriptively summarized and narratively synthesized with reporting of key statistical properties of the models. Results: We identified 20,487 studies, of which 41 studies met our eligibility criteria. We identified 16 unique risk prediction models. Overall, 50% (n = 8) of the risk prediction models were judged to be at low risk of bias. Only 13% of the studies (n = 2) were judged at low risk of bias for applicability, namely, PREDICT and QRISK3.Only the PREDICT risk calculator scored low risk in both domains. Conclusions: There is no existing ASCVD risk calculator particularly well suited for use in Qatar's ethnically diverse population. Of the available models, PREDICT and QRISK3 appear most appropriate because of their inclusion of ethnicity. In the absence of a locally derived ASCVD for Qatar, there is merit in a formal head-to-head comparison between PCE, which is currently in use, and PREDICT and QRISK3.

scholarly journals Risk Prediction Models for Patients With Acute Heart Failure: A Protocol for Systematic Review, Critical Appraisal, and Meta-Analysis

2021 ◽  
Author(s):  
Xuecheng Zhang ◽  
Kehua Zhou ◽  
Jingjing Zhang ◽  
Ying Chen ◽  
Hengheng Dai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Prediction Model ◽  
Acute Heart Failure ◽  
Risk Prediction ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Prediction Models ◽  
Cochrane Library ◽  
Risk Prediction Models

Abstract Background Nearly a third of patients with acute heart failure (AHF) die or are readmitted within three months after discharge, accounting for the majority of costs associated with heart failure-related care. A considerable number of risk prediction models, which predict outcomes for mortality and readmission rates, have been developed and validated for patients with AHF. These models could help clinicians stratify patients by risk level and improve decision making, and provide specialist care and resources directed to high-risk patients. However, clinicians sometimes reluctant to utilize these models, possibly due to their poor reliability, the variety of models, and/or the complexity of statistical methodologies. Here, we describe a protocol to systematically review extant risk prediction models. We will describe characteristics, compare performance, and critically appraise the reporting transparency and methodological quality of risk prediction models for AHF patients. Method Embase, Pubmed, Web of Science, and the Cochrane Library will be searched from their inception onwards. A back word will be searched on derivation studies to find relevant external validation studies. Multivariable prognostic models used for AHF and mortality and/or readmission rate will be eligible for review. Two reviewers will conduct title and abstract screening, full-text review, and data extraction independently. Included models will be summarized qualitatively and quantitatively. We will also provide an overview of critical appraisal of the methodological quality and reporting transparency of included studies using the Prediction model Risk of Bias Assessment Tool(PROBAST tool) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis(TRIPOD statement). Discussion The result of the systematic review could help clinicians better understand and use the prediction models for AHF patients, as well as make standardized decisions about more precise, risk-adjusted management. Systematic review registration : PROSPERO registration number CRD42021256416.

scholarly journals Improving Outcome Predictions for Patients Receiving Mechanical Circulatory Support by Optimizing Imputation of Missing Values

2021 ◽  
Author(s):  
Byron C. Jaeger ◽  
Ryan Cantor ◽  
Venkata Sthanam ◽  
Rongbing Xie ◽  
James K. Kirklin ◽  
...  
Keyword(s):  
Multiple Imputation ◽  
Risk Prediction ◽  
Random Forests ◽  
Missing Values ◽  
Prediction Models ◽  
Model Performance ◽  
Circulatory Support ◽  
Risk Prediction Models ◽  
Prognostic Accuracy ◽  
The Mean

Background: Risk prediction models play an important role in clinical decision making. When developing risk prediction models, practitioners often impute missing values to the mean. We evaluated the impact of applying other strategies to impute missing values on the prognostic accuracy of downstream risk prediction models, that is, models fitted to the imputed data. A secondary objective was to compare the accuracy of imputation methods based on artificially induced missing values. To complete these objectives, we used data from the Interagency Registry for Mechanically Assisted Circulatory Support. Methods: We applied 12 imputation strategies in combination with 2 different modeling strategies for mortality and transplant risk prediction following surgery to receive mechanical circulatory support. Model performance was evaluated using Monte-Carlo cross-validation and measured based on outcomes 6 months following surgery using the scaled Brier score, concordance index, and calibration error. We used Bayesian hierarchical models to compare model performance. Results: Multiple imputation with random forests emerged as a robust strategy to impute missing values, increasing model concordance by 0.0030 (25th–75th percentile: 0.0008–0.0052) compared with imputation to the mean for mortality risk prediction using a downstream proportional hazards model. The posterior probability that single and multiple imputation using random forests would improve concordance versus mean imputation was 0.464 and >0.999, respectively. Conclusions: Selecting an optimal strategy to impute missing values such as random forests and applying multiple imputation can improve the prognostic accuracy of downstream risk prediction models.

scholarly journals Risk Prediction Models for Mortality in Community-Acquired Pneumonia: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Chun Shing Kwok ◽  
Yoon K. Loke ◽  
Kenneth Woo ◽  
Phyo Kyaw Myint
Keyword(s):  
Risk Prediction ◽  
Prediction Models ◽  
Community Acquired Pneumonia ◽  
Convincing Evidence ◽  
Mortality Prediction ◽  
Cochrane Library ◽  
Discriminative Ability ◽  
Risk Prediction Models ◽  
Clinical Variables ◽  
Risk Of Mortality

Background. Several models have been developed to predict the risk of mortality in community-acquired pneumonia (CAP). This study aims to systematically identify and evaluate the performance of published risk prediction models for CAP.Methods. We searched MEDLINE, EMBASE, and Cochrane library in November 2011 for initial derivation and validation studies for models which predict pneumonia mortality. We aimed to present the comparative usefulness of their mortality prediction.Results. We identified 20 different published risk prediction models for mortality in CAP. Four models relied on clinical variables that could be assessed in community settings, with the two validated models BTS1 and CRB-65 showing fairly similar balanced accuracy levels (0.77 and 0.72, resp.), while CRB-65 had AUROC of 0.78. Nine models required laboratory tests in addition to clinical variables, and the best performance levels amongst the validated models were those of CURB and CURB-65 (balanced accuracy 0.73 and 0.71, resp.), with CURB-65 having an AUROC of 0.79. The PSI (AUROC 0.82) was the only validated model with good discriminative ability among the four that relied on clinical, laboratorial, and radiological variables.Conclusions. There is no convincing evidence that other risk prediction models improve upon the well-established CURB-65 and PSI models.

scholarly journals Risk Prediction Models for Liver Cancer in Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Maomao Cao ◽  
He Li ◽  
Dianqin Sun ◽  
Siyi He ◽  
Yadi Zheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Liver Cancer ◽  
Risk Prediction ◽  
Prediction Models ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Risk Models ◽  
Risk Prediction Models ◽  
Prediction Risk

Abstract Background Prediction of liver cancer risk is beneficial to define high-risk population of liver cancer and guide clinical decisions. We aimed to review and critically appraise the quality of existing risk-prediction models for liver cancer. Methods This systematic review followed the guidelines of CHARMS (Checklist for Critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) and Preferred Reporting Items for Systematic Reviews and Meta (PRISMA). We searched for PubMed, Embase, Web of Science, and the Cochrane Library from inception to July 2020. Prediction model Risk Of Bias Assessment Tool was used to assess the risk of bias of all potential articles. A narrative description and meta-analysis were conducted. Results After removal irrespective and duplicated citations, 20 risk prediction publications were finally included. Within the 20 studies, 15 studies performed model derivation and validation process, three publications only conducted developed procedure without validation and two articles were used to validate existing models. Discrimination was expressed as area under curve or C statistic, which was acceptable for most models, ranging from 0.64 to 0.96. Calibration of the predictions model were rarely assessed. All models were graded at high risk of bias. The risk bias of applicability in 13 studies was considered low. Conclusions This systematic review gives an overall review of the prediction risk models for liver cancer, pointing out several methodological issues in their development. No prediction risk models were recommended due to the high risk of bias.Systematic review registration: This systematic has been registered in PROSPERO (International Prospective Register of Systemic Review: CRD42020203244).

scholarly journals Generalizability Challenges of Mortality Risk Prediction Models: A Retrospective Analysis on a Multi-center Database

2021 ◽  
Author(s):  
Harvineet Singh ◽  
Vishwali Mhasawade ◽  
Rumi Chunara
Keyword(s):  
Hospital Mortality ◽  
Risk Prediction ◽  
Performance Metrics ◽  
Prediction Models ◽  
Characteristic Curve ◽  
False Negative ◽  
Model Performance ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Risk Prediction Models

Importance: Modern predictive models require large amounts of data for training and evaluation which can result in building models that are specific to certain locations, populations in them and clinical practices. Yet, best practices and guidelines for clinical risk prediction models have not yet considered such challenges to generalizability. Objectives: To investigate changes in measures of predictive discrimination, calibration, and algorithmic fairness when transferring models for predicting in-hospital mortality across ICUs in different populations. Also, to study the reasons for the lack of generalizability in these measures. Design, Setting, and Participants: In this multi-center cross-sectional study, electronic health records from 179 hospitals across the US with 70,126 hospitalizations were analyzed. Time of data collection ranged from 2014 to 2015. Main Outcomes and Measures: The main outcome is in-hospital mortality. Generalization gap, defined as difference between model performance metrics across hospitals, is computed for discrimination and calibration metrics, namely area under the receiver operating characteristic curve (AUC) and calibration slope. To assess model performance by race variable, we report differences in false negative rates across groups. Data were also analyzed using a causal discovery algorithm "Fast Causal Inference" (FCI) that infers paths of causal influence while identifying potential influences associated with unmeasured variables. Results: In-hospital mortality rates differed in the range of 3.9%-9.3% (1st-3rd quartile) across hospitals. When transferring models across hospitals, AUC at the test hospital ranged from 0.777 to 0.832 (1st to 3rd quartile; median 0.801); calibration slope from 0.725 to 0.983 (1st to 3rd quartile; median 0.853); and disparity in false negative rates from 0.046 to 0.168 (1st to 3rd quartile; median 0.092). When transferring models across geographies, AUC ranged from 0.795 to 0.813 (1st to 3rd quartile; median 0.804); calibration slope from 0.904 to 1.018 (1st to 3rd quartile; median 0.968); and disparity in false negative rates from 0.018 to 0.074 (1st to 3rd quartile; median 0.040). Distribution of all variable types (demography, vitals, and labs) differed significantly across hospitals and regions. Shifts in the race variable distribution and some clinical (vitals, labs and surgery) variables by hospital or region. Race variable also mediates differences in the relationship between clinical variables and mortality, by hospital/region. Conclusions and Relevance: Group-specific metrics should be assessed during generalizability checks to identify potential harms to the groups. In order to develop methods to improve and guarantee performance of prediction models in new environments for groups and individuals, better understanding and provenance of health processes as well as data generating processes by sub-group are needed to identify and mitigate sources of variation.

scholarly journals Summarising and synthesising regression coefficients through systematic review and meta-analysis for improving hypertension prediction using metamodelling: protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e036388
Author(s):  
Mohammad Ziaul Islam Chowdhury ◽  
Iffat Naeem ◽  
Hude Quan ◽  
Alexander A Leung ◽  
Khokan C Sikdar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Prediction ◽  
Prediction Models ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Grey Literature ◽  
Random Effect ◽  
Regression Coefficients ◽  
Risk Prediction Models

IntroductionHypertension is one of the most common medical conditions and represents a major risk factor for heart attack, stroke, kidney disease and mortality. The risk of progression to hypertension depends on several factors, and combining these risk factors into a multivariable model for risk stratification would help to identify high-risk individuals who should be targeted for healthy behavioural changes and/or medical treatment to prevent the development of hypertension. The risk prediction models can be further improved in terms of accuracy by using a metamodel updating technique where existing hypertension prediction models can be updated by combining information available in existing models with new data. A systematic review and meta-analysis will be performed of hypertension prediction models in order to identify known risk factors for high blood pressure and to summarise the magnitude of their association with hypertension.Methods and analysisMEDLINE, Embase, Web of Science, Scopus and grey literature will be systematically searched for studies predicting the risk of hypertension among the general population. The search will be based on two key concepts: hypertension and risk prediction. The summary statistics from the individual studies will be the regression coefficients of the hypertension risk prediction models, and random-effect meta-analysis will be used to obtain pooled estimates. Heterogeneity and publication bias will be assessed, along with study quality, which will be assessed using the Prediction Model Risk of Bias Assessment Tool checklist.Ethics and disseminationEthics approval is not required for this systematic review and meta-analysis. We plan to disseminate the results of our review through journal publications and presentations at applicable platforms.

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