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Sangnawakij P, Böhning D, Holling H, Jansen K. Nonparametric estimation of the random effects distribution for the risk or rate ratio in rare events meta-analysis with the arm-based and contrast-based approaches. Stat Med 2024; 43:706-730. [PMID: 38111986 DOI: 10.1002/sim.9981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/28/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
Rare events are events which occur with low frequencies. These often arise in clinical trials or cohort studies where the data are arranged in binary contingency tables. In this article, we investigate the estimation of effect heterogeneity for the risk-ratio parameter in meta-analysis of rare events studies through two likelihood-based nonparametric mixture approaches: an arm-based and a contrast-based model. Maximum likelihood estimation is achieved using the EM algorithm. Special attention is given to the choice of initial values. Inspired by the classification likelihood, a strategy is implemented which repeatably uses random allocation of the studies to the mixture components as choice of initial values. The likelihoods under the contrast-based and arm-based approaches are compared and differences are highlighted. We use simulations to assess the performance of these two methods. Under the design of sampling studies with nested treatment groups, the results show that the nonparametric mixture model based on the contrast-based approach is more appropriate in terms of model selection criteria such as AIC and BIC. Under the arm-based design the results from the arm-based model performs well although in some cases it is also outperformed by the contrast-based model. Comparisons of the estimators are provided in terms of bias and mean squared error. Also included in the comparison is the mixed Poisson regression model as well as the classical DerSimonian-Laird model (using the Mantel-Haenszel estimator for the common effect). Using simulation, estimating effect heterogeneity in the case of the contrast-based method appears to behave better than the compared methods although differences become negligible for large within-study sample sizes. We illustrate the methodologies using several meta-analytic data sets in medicine.
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Affiliation(s)
- Patarawan Sangnawakij
- Department of Mathematics and Statistics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| | - Dankmar Böhning
- Mathematical Sciences and Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Heinz Holling
- Institute of Psychology, University of Münster, Münster, Germany
| | - Katrin Jansen
- Institute of Psychology, University of Münster, Münster, Germany
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Garaba A, Aslam N, Ponzio F, Panciani PP, Brinjikji W, Fontanella M, De Maria L. Radiomics for differentiation of gliomas from primary central nervous system lymphomas: a systematic review and meta-analysis. Front Oncol 2024; 14:1291861. [PMID: 38420015 PMCID: PMC10899458 DOI: 10.3389/fonc.2024.1291861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background and objective Numerous radiomics-based models have been proposed to discriminate between central nervous system (CNS) gliomas and primary central nervous system lymphomas (PCNSLs). Given the heterogeneity of the existing models, we aimed to define their overall performance and identify the most critical variables to pilot future algorithms. Methods A systematic review of the literature and a meta-analysis were conducted, encompassing 12 studies and a total of 1779 patients, focusing on radiomics to differentiate gliomas from PCNSLs. A comprehensive literature search was performed through PubMed, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus databases. Overall sensitivity (SEN) and specificity (SPE) were estimated. Event rates were pooled using a random-effects meta-analysis, and the heterogeneity was assessed using the χ2 test. Results The overall SEN and SPE for differentiation between CNS gliomas and PCNSLs were 88% (95% CI = 0.83 - 0.91) and 87% (95% CI = 0.83 - 0.91), respectively. The best-performing features were the ones extracted from the Gray Level Run Length Matrix (GLRLM; ACC 97%), followed by those obtained from the Neighboring Gray Tone Difference Matrix (NGTDM; ACC 93%), and shape-based features (ACC 91%). The 18F-FDG-PET/CT was the best-performing imaging modality (ACC 97%), followed by the MRI CE-T1W (ACC 87% - 95%). Most studies applied a cross-validation analysis (92%). Conclusion The current SEN and SPE of radiomics to discriminate CNS gliomas from PCNSLs are high, making radiomics a helpful method to differentiate these tumor types. The best-performing features are the GLRLM, NGTDM, and shape-based features. The 18F-FDG-PET/CT imaging modality is the best-performing, while the MRI CE-T1W is the most used.
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Affiliation(s)
- Alexandru Garaba
- Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nummra Aslam
- Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Ponzio
- Interuniversity Department of Regional and Urban Studies and Planning, Politecnico di Torino, Torino, Italy
| | - Pier Paolo Panciani
- Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Waleed Brinjikji
- Department of Neurosurgery and Interventional Neuroradiology, Mayo Clinic, Rochester, MN, United States
| | - Marco Fontanella
- Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Lucio De Maria
- Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Clinical Neuroscience, Geneva University Hospitals (HUG), Geneva, Switzerland
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Babačić H, Christ W, Araújo JE, Mermelekas G, Sharma N, Tynell J, García M, Varnaite R, Asgeirsson H, Glans H, Lehtiö J, Gredmark-Russ S, Klingström J, Pernemalm M. Comprehensive proteomics and meta-analysis of COVID-19 host response. Nat Commun 2023; 14:5921. [PMID: 37739942 PMCID: PMC10516886 DOI: 10.1038/s41467-023-41159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/24/2023] [Indexed: 09/24/2023] Open
Abstract
COVID-19 is characterised by systemic immunological perturbations in the human body, which can lead to multi-organ damage. Many of these processes are considered to be mediated by the blood. Therefore, to better understand the systemic host response to SARS-CoV-2 infection, we performed systematic analyses of the circulating, soluble proteins in the blood through global proteomics by mass-spectrometry (MS) proteomics. Here, we show that a large part of the soluble blood proteome is altered in COVID-19, among them elevated levels of interferon-induced and proteasomal proteins. Some proteins that have alternating levels in human cells after a SARS-CoV-2 infection in vitro and in different organs of COVID-19 patients are deregulated in the blood, suggesting shared infection-related changes.The availability of different public proteomic resources on soluble blood proteome alterations leaves uncertainty about the change of a given protein during COVID-19. Hence, we performed a systematic review and meta-analysis of MS global proteomics studies of soluble blood proteomes, including up to 1706 individuals (1039 COVID-19 patients), to provide concluding estimates for the alteration of 1517 soluble blood proteins in COVID-19. Finally, based on the meta-analysis we developed CoViMAPP, an open-access resource for effect sizes of alterations and diagnostic potential of soluble blood proteins in COVID-19, which is publicly available for the research, clinical, and academic community.
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Affiliation(s)
- Haris Babačić
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Wanda Christ
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - José Eduardo Araújo
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Mermelekas
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nidhi Sharma
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Janne Tynell
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Marina García
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Renata Varnaite
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hedvig Glans
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Janne Lehtiö
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sara Gredmark-Russ
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå, Sweden
| | - Jonas Klingström
- Centre for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division of Molecular Medicine and Virology (MMV), Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Maria Pernemalm
- Science for Life Laboratory and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
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Lee J, van Es N, Takada T, Klok FA, Geersing GJ, Blume J, Bossuyt PM. Covariate-specific ROC curve analysis can accommodate differences between covariate subgroups in the evaluation of diagnostic accuracy. J Clin Epidemiol 2023; 160:14-23. [PMID: 37295733 DOI: 10.1016/j.jclinepi.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/01/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We present an illustrative application of methods that account for covariates in receiver operating characteristic (ROC) curve analysis, using individual patient data on D-dimer testing for excluding pulmonary embolism. STUDY DESIGN AND SETTING Bayesian nonparametric covariate-specific ROC curves were constructed to examine the performance/positivity thresholds in covariate subgroups. Standard ROC curves were constructed. Three scenarios were outlined based on comparison between subgroups and standard ROC curve conclusion: (1) identical distribution/identical performance, (2) different distribution/identical performance, and (3) different distribution/different performance. Scenarios were illustrated using clinical covariates. Covariate-adjusted ROC curves were also constructed. RESULTS Age groups had prominent differences in D-dimer concentration, paired with differences in performance (Scenario 3). Different positivity thresholds were required to achieve the same level of sensitivity. D-dimer had identical performance, but different distributions for YEARS algorithm items (Scenario 2), and similar distributions for sex (Scenario 1). For the later covariates, comparable positivity thresholds achieved the same sensitivity. All covariate-adjusted models had AUCs comparable to the standard approach. CONCLUSION Subgroup differences in performance and distribution of results can indicate that the conventional ROC curve is not a fair representation of test performance. Estimating conditional ROC curves can improve the ability to select thresholds with greater applicability.
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Affiliation(s)
- Jenny Lee
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima, 961-0005, Japan
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeffrey Blume
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima, 961-0005, Japan; Department of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Patrick M Bossuyt
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Holling H, Jansen K, Böhning W, Böhning D, Martin S, Sangnawakij P. Estimation of Effect Heterogeneity in Rare Events Meta-Analysis. Psychometrika 2022; 87:1081-1102. [PMID: 35133554 PMCID: PMC9433364 DOI: 10.1007/s11336-021-09835-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/14/2021] [Indexed: 06/14/2023]
Abstract
The paper outlines several approaches for dealing with meta-analyses of count outcome data. These counts are the accumulation of occurred events, and these events might be rare, so a special feature of the meta-analysis is dealing with low counts including zero-count studies. Emphasis is put on approaches which are state of the art for count data modelling including mixed log-linear (Poisson) and mixed logistic (binomial) regression as well as nonparametric mixture models for count data of Poisson and binomial type. A simulation study investigates the performance and capability of discrete mixture models in estimating effect heterogeneity. The approaches are exemplified on a meta-analytic case study investigating the acceptance of bibliotherapy.
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Affiliation(s)
- Heinz Holling
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany.
| | - Katrin Jansen
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Walailuck Böhning
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
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Hopkins D, Rickwood DJ, Hallford DJ, Watsford C. Structured data vs. unstructured data in machine learning prediction models for suicidal behaviors: A systematic review and meta-analysis. Front Digit Health 2022; 4:945006. [PMID: 35983407 PMCID: PMC9378826 DOI: 10.3389/fdgth.2022.945006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Suicide remains a leading cause of preventable death worldwide, despite advances in research and decreases in mental health stigma through government health campaigns. Machine learning (ML), a type of artificial intelligence (AI), is the use of algorithms to simulate and imitate human cognition. Given the lack of improvement in clinician-based suicide prediction over time, advancements in technology have allowed for novel approaches to predicting suicide risk. This systematic review and meta-analysis aimed to synthesize current research regarding data sources in ML prediction of suicide risk, incorporating and comparing outcomes between structured data (human interpretable such as psychometric instruments) and unstructured data (only machine interpretable such as electronic health records). Online databases and gray literature were searched for studies relating to ML and suicide risk prediction. There were 31 eligible studies. The outcome for all studies combined was AUC = 0.860, structured data showed AUC = 0.873, and unstructured data was calculated at AUC = 0.866. There was substantial heterogeneity between the studies, the sources of which were unable to be defined. The studies showed good accuracy levels in the prediction of suicide risk behavior overall. Structured data and unstructured data also showed similar outcome accuracy according to meta-analysis, despite different volumes and types of input data.
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Affiliation(s)
- Danielle Hopkins
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- *Correspondence: Danielle Hopkins
| | | | | | - Clare Watsford
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Sehovic E, Urru S, Chiorino G, Doebler P. Meta-analysis of diagnostic cell-free circulating microRNAs for breast cancer detection. BMC Cancer 2022; 22:634. [PMID: 35681127 PMCID: PMC9178880 DOI: 10.1186/s12885-022-09698-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/24/2022] [Indexed: 01/17/2023] Open
Abstract
Background Breast cancer (BC) is the most frequently diagnosed cancer among women. Numerous studies explored cell-free circulating microRNAs as diagnostic biomarkers of BC. As inconsistent and rarely intersecting microRNA panels have been reported thus far, we aim to evaluate the overall diagnostic performance as well as the sources of heterogeneity between studies. Methods Based on the search of three online search engines performed up to March 21st 2022, 56 eligible publications that investigated diagnostic circulating microRNAs by utilizing Real-Time Quantitative Reverse Transcription PCR (qRT-PCR) were obtained. Primary studies’ potential for bias was evaluated with the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2). A bivariate generalized linear mixed-effects model was applied to obtain pooled sensitivity and specificity. A novel methodology was utilized in which the sample and study models’ characteristics were analysed to determine the potential preference of studies for sensitivity or specificity. Results Pooled sensitivity and specificity of 0.85 [0.81—0.88] and 0.83 [0.79—0.87] were obtained, respectively. Subgroup analysis showed a significantly better performance of multiple (sensitivity: 0.90 [0.86—0.93]; specificity: 0.86 [0.80—0.90]) vs single (sensitivity: 0.82 [0.77—0.86], specificity: 0.83 [0.78—0.87]) microRNA panels and a comparable pooled diagnostic performance between studies using serum (sensitivity: 0.87 [0.81—0.91]; specificity: 0.83 [0.78—0.87]) and plasma (sensitivity: 0.83 [0.77—0.87]; specificity: 0.85 [0.78—0.91]) as specimen type. In addition, based on bivariate and univariate analyses, miRNA(s) based on endogenous normalizers tend to have a higher diagnostic performance than miRNA(s) based on exogenous ones. Moreover, a slight tendency of studies to prefer specificity over sensitivity was observed. Conclusions In this study the diagnostic ability of circulating microRNAs to diagnose BC was reaffirmed. Nonetheless, some subgroup analyses showed between-study heterogeneity. Finally, lack of standardization and of result reproducibility remain the biggest issues regarding the diagnostic application of circulating cell-free microRNAs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09698-8.
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Affiliation(s)
- Emir Sehovic
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, 13900, Biella, Italy. .,Department of Life Sciences and Systems Biology, University of Turin, 10100, Turin, Italy.
| | - Sara Urru
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, 13900, Biella, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35121, Padova, Italy
| | - Giovanna Chiorino
- Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia, 13900, Biella, Italy
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, 44227, Dortmund, Germany
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Luo C, Marks‐Anglin A, Duan R, Lin L, Hong C, Chu H, Chen Y. Accounting for publication bias using a bivariate trim and fill meta‐analysis procedure. Stat Med 2022; 41:3466-3478. [DOI: 10.1002/sim.9428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Chongliang Luo
- Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania Philadelphia Pennsylvania USA
- Division of Public Health Sciences Washington University in St. Louis St Louis Missouri USA
| | - Arielle Marks‐Anglin
- Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania Philadelphia Pennsylvania USA
| | - Rui Duan
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts USA
| | - Lifeng Lin
- Department of Statistics Florida State University Tallahassee Florida USA
| | - Chuan Hong
- Department of Biostatistics & Bioinformatics Duke University Durham North Carolina USA
| | - Haitao Chu
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis Minnesota USA
- Statistical Research and Innovation, Global Biometrics and Data Management Pfizer Inc. New York New York USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania Philadelphia Pennsylvania USA
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Yang CH, Moi SH, Chuang LY, Chen JB. Higher-order clinical risk factor interaction analysis for overall mortality in maintenance hemodialysis patients. Ther Adv Chronic Dis 2020; 11:2040622320949060. [PMID: 33062235 PMCID: PMC7534064 DOI: 10.1177/2040622320949060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 07/20/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIMS In Taiwan, approximately 90% of patients with end-stage renal disease receive maintenance hemodialysis. Although studies have reported the survival predictability of multiclinical factors, the higher-order interactions among these factors have rarely been discussed. Conventional statistical approaches such as regression analysis are inadequate for detecting higher-order interactions. Therefore, this study integrated receiver operating characteristic, logistic regression, and balancing functions for adjusting the ratio in risk classes and classification errors for imbalanced cases and controls using multifactor-dimensionality reduction (MDR-ER) analyses to examine the impact of interaction effects between multiclinical factors on overall mortality in patients on maintenance hemodialysis. METERIALS AND METHODS In total, 781 patients who received outpatient hemodialysis dialysis three times per week before 1 January 2009 were included; their baseline clinical factor and mortality outcome data were retrospectively collected using an approved data protocol (201800595B0). RESULTS Consistent with conventional statistical approaches, the higher-order interaction model could indicate the impact of potential risk combination unique to patients on maintenance hemodialysis on the survival outcome, as described previously. Moreover, the MDR-based higher-order interaction model facilitated higher-order interaction effect detection among multiclinical factors and could determine more detailed mortality risk characteristics combinations. CONCLUSION Therefore, higher-order clinical risk interaction analysis is a reasonable strategy for detecting non-traditional risk factor interaction effects on survival outcome unique to patients on maintenance hemodialysis and thus clinically achieving whole-scale patient care.
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Affiliation(s)
- Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung Ph.D. Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung
| | - Sin-Hua Moi
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung
| | - Li-Yeh Chuang
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84004
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 DaPei Rd, Niao Song Dist, Kaohsiung 83301
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Affiliation(s)
- Heinz Holling
- Statistics and Quantitative Methods, Faculty of Psychology and Sport Science, University of Münster, Münster, Germany
| | - Walailuck Böhning
- Statistics and Quantitative Methods, Faculty of Psychology and Sport Science, University of Münster, Münster, Germany
| | - Ehsan Masoudi
- Statistics and Quantitative Methods, Faculty of Psychology and Sport Science, University of Münster, Münster, Germany
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Patarawan Sangnawakij
- Department of Mathematics and Statistics, Thammasat University, Pathumthani, Thailand
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Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann RT. Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis. Eur Radiol 2019; 29:806-17. [PMID: 30014203 DOI: 10.1007/s00330-018-5626-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/13/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis of published data to evaluate the utility of chemical shift imaging (CSI) for differentiating between adrenal adenomas and non-adenomas. METHODS A systematic search of the MEDLINE, Web of Science Core Collection, EMBASE and Cochrane Central Register of Controlled Trials electronic databases was performed. The methodological quality of the included studies was assessed by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. A bivariate random effect model was used to determine summary and subgroup sensitivity and specificity and calculate summary receiver operating characteristic curves (SROC). RESULTS Eighteen studies with 1138 patients and 1280 lesions (859 adenomas, 421 non-adenomas) in total were included. In addition to summary analysis, quantitative analyses of the adrenal signal intensity index (SII, 978 lesions, 14 studies), adrenal-to-spleen ratio (ASR; 394 lesions, 7 studies) and visual analysis (560 lesions, 5 studies) were performed. The resultant data showed considerable heterogeneity (inconsistency index I2 of 94%, based on the diagnostic odds ratio, DOR). The pooled sensitivity of CSI for adenoma was 0.94 [95% confidence interval (CI) 0.88-0.97] and pooled specificity was 0.95 (95% CI 0.89-0.97). The area (AUC) under the SROC curve was 0.98 (95% CI 0.96-0.99). The corresponding AUCs were 0.98, 0.99 and 0.95 for SII, ASR and visual evaluation, respectively. CONCLUSION CSI has high sensitivity, specificity and accuracy for adrenal adenoma. Diagnostic performance does not improve when quantitative indices are used. KEY POINTS • Inclusion of CSI in abdominal MRI protocols provides an effective solution for classifying adrenal masses discovered on MR exams • Visual evaluation of adrenal CSI is sufficient; use of quantitative indices does not improve diagnostic accuracy.
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Abstract
OBJECTIVES To distinguish between variation in referral threshold and variation in accurate selection of patients for referral in fast-track referrals for possible cancer. To examine factors associated with threshold and accuracy and model the effects of changing thresholds. DESIGN Analysis of national data on cancer referrals from general practices in England over a 5-year period. We developed a new method to estimate specificity of referral to complement existing sensitivity. We used bivariate meta-analysis to produce summary measures and described practices in relation to these. SETTING 5479 general practitioner (GP) practices with data relating to more than 50 cancer cases diagnosed over the 5 years. OUTCOMES Number of practices whose 95% confidence regions for sensitivity and specificity indicated that they were outliers in terms of either referral threshold or decision accuracy. RESULTS 2019 practices (36.8%) were outliers in relation to referral threshold compared with 1205 practices (22%) in relation to decision accuracy. Practice age profile, cancer incidence and deprivation showed a modest association with decision accuracy but not with thresholds. If all practices shared the referral behaviour of those in the highest quintile of age-standardised referral rate, there would be a 3.3% increase in cancers detected through fast-track pathways at the cost of a 36.9% increase in urgent referrals. CONCLUSION This new method permits variation in referral to be described more precisely and quality improvement activities to be targeted. Changing referral thresholds without increasing accuracy will result in modest effects on detection rates and a large increase in demand on diagnostic services.
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Affiliation(s)
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Amanda J Lee
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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