Diagnostic and prognostic research最新文献

{"title":"A study protocol of external validation of eight COVID-19 prognostic models for predicting mortality risk in older populations in a hospital, primary care, and nursing home setting.","authors":"Anum Zahra,&nbsp;Kim Luijken,&nbsp;Evertine J Abbink,&nbsp;Jesse M van den Berg,&nbsp;Marieke T Blom,&nbsp;Petra Elders,&nbsp;Jan Festen,&nbsp;Jacobijn Gussekloo,&nbsp;Karlijn J Joling,&nbsp;René Melis,&nbsp;Simon Mooijaart,&nbsp;Jeannette B Peters,&nbsp;Harmke A Polinder-Bos,&nbsp;Bas F M van Raaij,&nbsp;Annemieke Smorenberg,&nbsp;Hannah M la Roi-Teeuw,&nbsp;Karel G M Moons,&nbsp;Maarten van Smeden","doi":"10.1186/s41512-023-00144-2","DOIUrl":"https://doi.org/10.1186/s41512-023-00144-2","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has a large impact worldwide and is known to particularly affect the older population. This paper outlines the protocol for external validation of prognostic models predicting mortality risk after presentation with COVID-19 in the older population. These prognostic models were originally developed in an adult population and will be validated in an older population (≥ 70 years of age) in three healthcare settings: the hospital setting, the primary care setting, and the nursing home setting.</p><p><strong>Methods: </strong>Based on a living systematic review of COVID-19 prediction models, we identified eight prognostic models predicting the risk of mortality in adults with a COVID-19 infection (five COVID-19 specific models: GAL-COVID-19 mortality, 4C Mortality Score, NEWS2 + model, Xie model, and Wang clinical model and three pre-existing prognostic scores: APACHE-II, CURB65, SOFA). These eight models will be validated in six different cohorts of the Dutch older population (three hospital cohorts, two primary care cohorts, and a nursing home cohort). All prognostic models will be validated in a hospital setting while the GAL-COVID-19 mortality model will be validated in hospital, primary care, and nursing home settings. The study will include individuals ≥ 70 years of age with a highly suspected or PCR-confirmed COVID-19 infection from March 2020 to December 2020 (and up to December 2021 in a sensitivity analysis). The predictive performance will be evaluated in terms of discrimination, calibration, and decision curves for each of the prognostic models in each cohort individually. For prognostic models with indications of miscalibration, an intercept update will be performed after which predictive performance will be re-evaluated.</p><p><strong>Discussion: </strong>Insight into the performance of existing prognostic models in one of the most vulnerable populations clarifies the extent to which tailoring of COVID-19 prognostic models is needed when models are applied to the older population. Such insight will be important for possible future waves of the COVID-19 pandemic or future pandemics.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9270992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a physical frailty phenotype index-based model to estimate the frailty index.","authors":"Yong-Hao Pua, Laura Tay, Ross Allan Clark, Julian Thumboo, Ee-Ling Tay, Shi-Min Mah, Pei-Yueng Lee, Yee-Sien Ng","doi":"10.1186/s41512-023-00143-3","DOIUrl":"10.1186/s41512-023-00143-3","url":null,"abstract":"<p><strong>Background: </strong>The conventional count-based physical frailty phenotype (PFP) dichotomizes its criterion predictors-an approach that creates information loss and depends on the availability of population-derived cut-points. This study proposes an alternative approach to computing the PFP by developing and validating a model that uses PFP components to predict the frailty index (FI) in community-dwelling older adults, without the need for predictor dichotomization.</p><p><strong>Methods: </strong>A sample of 998 community-dwelling older adults (mean [SD], 68 [7] years) participated in this prospective cohort study. Participants completed a multi-domain geriatric screen and a physical fitness assessment from which the count-based PFP and the 36-item FI were computed. One-year prospective falls and hospitalization rates were also measured. Bayesian beta regression analysis, allowing for nonlinear effects of the non-dichotomized PFP criterion predictors, was used to develop a model for FI (\"model-based PFP\"). Approximate leave-one-out (LOO) cross-validation was used to examine model overfitting.</p><p><strong>Results: </strong>The model-based PFP showed good calibration with the FI, and it had better out-of-sample predictive performance than the count-based PFP (LOO-R², 0.35 vs 0.22). In clinical terms, the improvement in prediction (i) translated to improved classification agreement with the FI (Cohen's k_w, 0.47 vs 0.36) and (ii) resulted primarily in a 23% (95%CI, 18-28%) net increase in FI-defined \"prefrail/frail\" participants correctly classified. The model-based PFP showed stronger prognostic performance for predicting falls and hospitalization than did the count-based PFP.</p><p><strong>Conclusion: </strong>The developed model-based PFP predicted FI and clinical outcomes more strongly than did the count-based PFP in community-dwelling older adults. By not requiring predictor cut-points, the model-based PFP potentially facilitates usage and feasibility. Future validation studies should aim to obtain clear evidence on the benefits of this approach.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10029224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9161565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical prediction model for prognosis in kidney transplant recipients (KIDMO): study protocol.","authors":"Simon Schwab, Daniel Sidler, Fadi Haidar, Christian Kuhn, Stefan Schaub, Michael Koller, Katell Mellac, Ueli Stürzinger, Bruno Tischhauser, Isabelle Binet, Déla Golshayan, Thomas Müller, Andreas Elmer, Nicola Franscini, Nathalie Krügel, Thomas Fehr, Franz Immer","doi":"10.1186/s41512-022-00139-5","DOIUrl":"10.1186/s41512-022-00139-5","url":null,"abstract":"<p><strong>Background: </strong>Many potential prognostic factors for predicting kidney transplantation outcomes have been identified. However, in Switzerland, no widely accepted prognostic model or risk score for transplantation outcomes is being routinely used in clinical practice yet. We aim to develop three prediction models for the prognosis of graft survival, quality of life, and graft function following transplantation in Switzerland.</p><p><strong>Methods: </strong>The clinical kidney prediction models (KIDMO) are developed with data from a national multi-center cohort study (Swiss Transplant Cohort Study; STCS) and the Swiss Organ Allocation System (SOAS). The primary outcome is the kidney graft survival (with death of recipient as competing risk); the secondary outcomes are the quality of life (patient-reported health status) at 12 months and estimated glomerular filtration rate (eGFR) slope. Organ donor, transplantation, and recipient-related clinical information will be used as predictors at the time of organ allocation. We will use a Fine & Gray subdistribution model and linear mixed-effects models for the primary and the two secondary outcomes, respectively. Model optimism, calibration, discrimination, and heterogeneity between transplant centres will be assessed using bootstrapping, internal-external cross-validation, and methods from meta-analysis.</p><p><strong>Discussion: </strong>Thorough evaluation of the existing risk scores for the kidney graft survival or patient-reported outcomes has been lacking in the Swiss transplant setting. In order to be useful in clinical practice, a prognostic score needs to be valid, reliable, clinically relevant, and preferably integrated into the decision-making process to improve long-term patient outcomes and support informed decisions for clinicians and their patients. The state-of-the-art methodology by taking into account competing risks and variable selection using expert knowledge is applied to data from a nationwide prospective multi-center cohort study. Ideally, healthcare providers together with patients can predetermine the risk they are willing to accept from a deceased-donor kidney, with graft survival, quality of life, and graft function estimates available for their consideration.</p><p><strong>Study registration: </strong>Open Science Framework ID: z6mvj.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9084527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study.","authors":"Kristina D Michaux,&nbsp;Rebecca K Metcalfe,&nbsp;Paloma Burns,&nbsp;Annalijn I Conklin,&nbsp;Alison M Hoens,&nbsp;Daniel Smith,&nbsp;Laura Struik,&nbsp;Abdollah Safari,&nbsp;Don D Sin,&nbsp;Mohsen Sadatsafavi","doi":"10.1186/s41512-023-00140-6","DOIUrl":"https://doi.org/10.1186/s41512-023-00140-6","url":null,"abstract":"<p><strong>Introduction: </strong>Personalized disease management informed by quantitative risk prediction has the potential to improve patient care and outcomes. The integration of risk prediction into clinical workflow should be informed by the experiences and preferences of stakeholders, and the impact of such integration should be evaluated in prospective comparative studies. The objectives of the IMplementing Predictive Analytics towards efficient chronic obstructive pulmonary disease (COPD) treatments (IMPACT) study are to integrate an exacerbation risk prediction tool into routine care and to determine its impact on prescription appropriateness (primary outcome), medication adherence, quality of life, exacerbation rates, and sex and gender disparities in COPD care (secondary outcomes).</p><p><strong>Methods: </strong>IMPACT will be conducted in two phases. Phase 1 will include the systematic and user-centered development of two decision support tools: (1) a decision tool for pulmonologists called the ACCEPT decision intervention (ADI), which combines risk prediction from the previously developed Acute COPD Exacerbation Prediction Tool with treatment algorithms recommended by the Canadian Thoracic Society's COPD pharmacotherapy guidelines, and (2) an information pamphlet for COPD patients (patient tool), tailored to their prescribed medication, clinical needs, and lung function. In phase 2, we will conduct a stepped-wedge cluster randomized controlled trial in two outpatient respiratory clinics to evaluate the impact of the decision support tools on quality of care and patient outcomes. Clusters will be practicing pulmonologists (n ≥ 24), who will progressively switch to the intervention over 18 months. At the end of the study, a qualitative process evaluation will be carried out to determine the barriers and enablers of uptake of the tools.</p><p><strong>Discussion: </strong>The IMPACT study coincides with a planned harmonization of electronic health record systems across tertiary care centers in British Columbia, Canada. The harmonization of these systems combined with IMPACT's implementation-oriented design and partnership with stakeholders will facilitate integration of the tools into routine care, if the results of the proposed study reveal positive association with improvement in the process and outcomes of clinical care. The process evaluation at the end of the trial will inform subsequent design iterations before largescale implementation.</p><p><strong>Trial registration: </strong>NCT05309356.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9926816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a diagnostic prediction model for psoriasis severity.","authors":"Mie Sylow Liljendahl,&nbsp;Nikolai Loft,&nbsp;Alexander Egeberg,&nbsp;Lone Skov,&nbsp;Tri-Long Nguyen","doi":"10.1186/s41512-023-00141-5","DOIUrl":"https://doi.org/10.1186/s41512-023-00141-5","url":null,"abstract":"<p><strong>Background: </strong>While administrative health records such as national registries may be useful data sources to study the epidemiology of psoriasis, they do not generally contain information on disease severity.</p><p><strong>Objectives: </strong>To develop a diagnostic model to distinguish psoriasis severity based on administrative register data.</p><p><strong>Method: </strong>We conducted a retrospective registry-based cohort study using the Danish Skin Cohort linked with the Danish national registries. We developed a diagnostic model using a gradient boosting machine learning technique to predict moderate-to-severe psoriasis. We performed an internal validation of the model by bootstrapping to account for any optimism.</p><p><strong>Results: </strong>Among 4016 adult psoriasis patients (55.8% women, mean age 59 years) included in this study, 1212 (30.2%) patients were identified as having moderate-to-severe psoriasis. The diagnostic prediction model yielded a bootstrap-corrected discrimination performance: c-statistic equal to 0.73 [95% CI: 0.71-0.74]. The internal validation by bootstrap correction showed no substantial optimism in the results with a c-statistic of 0.72 [95% CI: 0.70-0.74]. A bootstrap-corrected slope of 1.10 [95% CI: 1.07-1.13] indicated a slight under-fitting.</p><p><strong>Conclusion: </strong>Based on register data, we developed a gradient boosting diagnostic model returning acceptable prediction of patients with moderate-to-severe psoriasis.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9903561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10674399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic accuracy of serum microRNAs in detection of cervical cancer: a systematic review protocol.","authors":"Frank Ssedyabane,&nbsp;Nixon Niyonzima,&nbsp;Joseph Ngonzi,&nbsp;Deusdedit Tusubira,&nbsp;Moses Ocan,&nbsp;Dickens Akena,&nbsp;Eve Namisango,&nbsp;Robert Apunyo,&nbsp;Alison Annet Kinengyere,&nbsp;Ekwaro A Obuku","doi":"10.1186/s41512-023-00142-4","DOIUrl":"https://doi.org/10.1186/s41512-023-00142-4","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer remains a public health problem worldwide, especially in sub-Saharan Africa. There are challenges in timely screening and diagnosis for early detection and intervention. Therefore, studies on cervical cancer and cervical intraepithelial neoplasia suggest the need for new diagnostic approaches including microRNA technology. Plasma/serum levels of microRNAs are elevated or reduced compared to the normal state and their diagnostic accuracy for detection of cervical neoplasms has not been rigorously assessed more so in low-resource settings such as Uganda. The aim of this systematic review was therefore to assess the diagnostic accuracy of serum microRNAs in detecting cervical cancer.</p><p><strong>Methods: </strong>We will perform a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. We will search for all articles in MEDLINE/PubMed, Web of Science, Embase, and CINAHL, as well as grey literature from 2012 to 2022. Our outcomes will be sensitivity, specificity, negative predictive values, positive predictive values or area under the curve (Nagamitsu et al, Mol Clin Oncol 5:189-94, 2016) for each microRNA or microRNA panel. We will use the quality assessment of diagnostic accuracy studies (Whiting et al, Ann Intern Med 155:529-36, 2011) tool to assess the risk of bias of included studies. Our results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy studies (PRISMA-DTA). We will summarise studies in a flow chart and then describe them using a structured narrative synthesis. If possible, we shall use the Lehmann model bivariate approach for the meta analysis USE OF THE REVIEW RESULTS: This systematic review will provide information on the relevance of microRNAs in cervical cancer. This information will help policy makers, planners and researchers in determining which particular microRNAs could be employed to screen or diagnose cancer of the cervix.</p><p><strong>Systematic review registration: </strong>This protocol has been registered in PROSPERO under registration number CRD42022313275.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9887905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9472616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BLOod Test Trend for cancEr Detection (BLOTTED): protocol for an observational and prediction model development study using English primary care electronic health record data.","authors":"Pradeep S Virdee,&nbsp;Clare Bankhead,&nbsp;Constantinos Koshiaris,&nbsp;Cynthia Wright Drakesmith,&nbsp;Jason Oke,&nbsp;Diana Withrow,&nbsp;Subhashisa Swain,&nbsp;Kiana Collins,&nbsp;Lara Chammas,&nbsp;Andres Tamm,&nbsp;Tingting Zhu,&nbsp;Eva Morris,&nbsp;Tim Holt,&nbsp;Jacqueline Birks,&nbsp;Rafael Perera,&nbsp;F D Richard Hobbs,&nbsp;Brian D Nicholson","doi":"10.1186/s41512-022-00138-6","DOIUrl":"https://doi.org/10.1186/s41512-022-00138-6","url":null,"abstract":"<p><strong>Background: </strong>Simple blood tests can play an important role in identifying patients for cancer investigation. The current evidence base is limited almost entirely to tests used in isolation. However, recent evidence suggests combining multiple types of blood tests and investigating trends in blood test results over time could be more useful to select patients for further cancer investigation. Such trends could increase cancer yield and reduce unnecessary referrals. We aim to explore whether trends in blood test results are more useful than symptoms or single blood test results in selecting primary care patients for cancer investigation. We aim to develop clinical prediction models that incorporate trends in blood tests to identify the risk of cancer.</p><p><strong>Methods: </strong>Primary care electronic health record data from the English Clinical Practice Research Datalink Aurum primary care database will be accessed and linked to cancer registrations and secondary care datasets. Using a cohort study design, we will describe patterns in blood testing (aim 1) and explore associations between covariates and trends in blood tests with cancer using mixed-effects, Cox, and dynamic models (aim 2). To build the predictive models for the risk of cancer, we will use dynamic risk modelling (such as multivariate joint modelling) and machine learning, incorporating simultaneous trends in multiple blood tests, together with other covariates (aim 3). Model performance will be assessed using various performance measures, including c-statistic and calibration plots.</p><p><strong>Discussion: </strong>These models will form decision rules to help general practitioners find patients who need a referral for further investigation of cancer. This could increase cancer yield, reduce unnecessary referrals, and give more patients the opportunity for treatment and improved outcomes.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10624854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted validation: validating clinical prediction models in their intended population and setting.","authors":"Matthew Sperrin, Richard D Riley, Gary S Collins, Glen P Martin","doi":"10.1186/s41512-022-00136-8","DOIUrl":"10.1186/s41512-022-00136-8","url":null,"abstract":"<p><p>Clinical prediction models must be appropriately validated before they can be used. While validation studies are sometimes carefully designed to match an intended population/setting of the model, it is common for validation studies to take place with arbitrary datasets, chosen for convenience rather than relevance. We call estimating how well a model performs within the intended population/setting \"targeted validation\". Use of this term sharpens the focus on the intended use of a model, which may increase the applicability of developed models, avoid misleading conclusions, and reduce research waste. It also exposes that external validation may not be required when the intended population for the model matches the population used to develop the model; here, a robust internal validation may be sufficient, especially if the development dataset was large.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"6 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10415716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for development and validation of postpartum cardiovascular disease (CVD) risk prediction model incorporating reproductive and pregnancy-related candidate predictors.","authors":"Steven Wambua,&nbsp;Francesca Crowe,&nbsp;Shakila Thangaratinam,&nbsp;Dermot O'Reilly,&nbsp;Colin McCowan,&nbsp;Sinead Brophy,&nbsp;Christopher Yau,&nbsp;Krishnarajah Nirantharakumar,&nbsp;Richard Riley","doi":"10.1186/s41512-022-00137-7","DOIUrl":"https://doi.org/10.1186/s41512-022-00137-7","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of death among women. CVD is associated with reduced quality of life, significant treatment and management costs, and lost productivity. Estimating the risk of CVD would help patients at a higher risk of CVD to initiate preventive measures to reduce risk of disease. The Framingham risk score and the QRISK® score are two risk prediction models used to evaluate future CVD risk in the UK. Although the algorithms perform well in the general population, they do not take into account pregnancy complications, which are well known risk factors for CVD in women and have been highlighted in a recent umbrella review. We plan to develop a robust CVD risk prediction model to assess the additional value of pregnancy risk factors in risk prediction of CVD in women postpartum.</p><p><strong>Methods: </strong>Using candidate predictors from QRISK®-3, the umbrella review identified from literature and from discussions with clinical experts and patient research partners, we will use time-to-event Cox proportional hazards models to develop and validate a 10-year risk prediction model for CVD postpartum using Clinical Practice Research Datalink (CPRD) primary care database for development and internal validation of the algorithm and the Secure Anonymised Information Linkage (SAIL) databank for external validation. We will then assess the value of additional candidate predictors to the QRISK®-3 in our internal and external validations.</p><p><strong>Discussion: </strong>The developed risk prediction model will incorporate pregnancy-related factors which have been shown to be associated with future risk of CVD but have not been taken into account in current risk prediction models. Our study will therefore highlight the importance of incorporating pregnancy-related risk factors into risk prediction modeling for CVD postpartum.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":"6 1","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9761974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9107521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a prognostic model for the early identification of COVID-19 patients at risk of developing common long COVID symptoms.","authors":"Manja Deforth,&nbsp;Caroline E Gebhard,&nbsp;Susan Bengs,&nbsp;Philipp K Buehler,&nbsp;Reto A Schuepbach,&nbsp;Annelies S Zinkernagel,&nbsp;Silvio D Brugger,&nbsp;Claudio T Acevedo,&nbsp;Dimitri Patriki,&nbsp;Benedikt Wiggli,&nbsp;Raphael Twerenbold,&nbsp;Gabriela M Kuster,&nbsp;Hans Pargger,&nbsp;Joerg C Schefold,&nbsp;Thibaud Spinetti,&nbsp;Pedro D Wendel-Garcia,&nbsp;Daniel A Hofmaenner,&nbsp;Bianca Gysi,&nbsp;Martin Siegemund,&nbsp;Georg Heinze,&nbsp;Vera Regitz-Zagrosek,&nbsp;Catherine Gebhard,&nbsp;Ulrike Held","doi":"10.1186/s41512-022-00135-9","DOIUrl":"https://doi.org/10.1186/s41512-022-00135-9","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic demands reliable prognostic models for estimating the risk of long COVID. We developed and validated a prediction model to estimate the probability of known common long COVID symptoms at least 60 days after acute COVID-19.</p><p><strong>Methods: </strong>The prognostic model was built based on data from a multicentre prospective Swiss cohort study. Included were adult patients diagnosed with COVID-19 between February and December 2020 and treated as outpatients, at ward or intensive/intermediate care unit. Perceived long-term health impairments, including reduced exercise tolerance/reduced resilience, shortness of breath and/or tiredness (REST), were assessed after a follow-up time between 60 and 425 days. The data set was split into a derivation and a geographical validation cohort. Predictors were selected out of twelve candidate predictors based on three methods, namely the augmented backward elimination (ABE) method, the adaptive best-subset selection (ABESS) method and model-based recursive partitioning (MBRP) approach. Model performance was assessed with the scaled Brier score, concordance c statistic and calibration plot. The final prognostic model was determined based on best model performance.</p><p><strong>Results: </strong>In total, 2799 patients were included in the analysis, of which 1588 patients were in the derivation cohort and 1211 patients in the validation cohort. The REST prevalence was similar between the cohorts with 21.6% (n = 343) in the derivation cohort and 22.1% (n = 268) in the validation cohort. The same predictors were selected with the ABE and ABESS approach. The final prognostic model was based on the ABE and ABESS selected predictors. The corresponding scaled Brier score in the validation cohort was 18.74%, model discrimination was 0.78 (95% CI: 0.75 to 0.81), calibration slope was 0.92 (95% CI: 0.78 to 1.06) and calibration intercept was -0.06 (95% CI: -0.22 to 0.09).</p><p><strong>Conclusion: </strong>The proposed model was validated to identify COVID-19-infected patients at high risk for REST symptoms. Before implementing the prognostic model in daily clinical practice, the conduct of an impact study is recommended.</p>","PeriodicalId":72800,"journal":{"name":"Diagnostic and prognostic research","volume":" ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}