随机对照试验meta分析中Doi图不对称的检验与解释。

IF 3.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Luis Furuya-Kanamori, Xanthoula Rousou, Polychronis Kostoulas, Suhail A R Doi
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引用次数: 0

摘要

系统评价和荟萃分析被认为是最高级别的证据,但它们的可靠性可能会受到发表偏倚的影响。评估发表偏倚的传统方法,如漏斗图和基于p值的检验(如Egger检验),有明显的局限性,包括依赖于主观解释和依赖于meta分析中纳入的研究数量(k)。Doi图和LFK指数提供了有希望的替代方案,提供了更好的可视化和量化图的不对称性。本研究回顾了Doi图和LFK指数在检测发表偏倚方面的应用,解决了最近的批评,并通过模拟研究评估了它们与基于p值的方法相比的性能。模拟包括使用Copas选择模型生成的不同研究数量(k = 5、10、20、50)、研究样本量(小、大)和模拟偏差水平(ρ = 0、-0.3、-0.5、-0.9)的场景。估计并比较LFK指数和Egger检验的诊断性能指标(即敏感性和特异性)。LFK指数在不同的k和模拟偏差水平上表现出一致的更高灵敏度。相反,Egger检验高度依赖于k,在小型荟萃分析中灵敏度急剧下降(k < 20)。LFK指标的特异性随随机误差进行调整,而Egger试验特异性保持固定在~ 90%。Doi图和LFK指数有效地解决了传统方法的局限性,提供了稳健的k无关性能和更可靠的发表偏倚检测。这些发现支持在荟萃分析中过渡到Doi图和LFK指数进行发表偏倚评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Examining and Interpreting Doi Plot Asymmetry in Meta-Analyses of Randomized Controlled Trials.

Systematic reviews and meta-analyses are considered the highest level of evidence, but their reliability can be undermined by publication bias. Traditional methods for assessing publication bias, such as funnel plots and p-value-based tests (e.g., Egger test), have notable limitations, including reliance on subjective interpretation and dependence on the number of studies included in a meta-analysis (k). The Doi plot and LFK index offer promising alternatives, providing improved visualization and quantification of plot asymmetry. This study revisits the application of the Doi plot and LFK index for detecting publication bias, addresses recent criticisms, and evaluates their performance compared to p-value-based methods using simulation study. Simulations included scenarios with varying study numbers (k = 5, 10, 20, 50), study sample sizes (small, large), and simulated bias level (ρ = 0, -0.3, -0.5, -0.9) generated using the Copas selection model. Diagnostic performance metrics (i.e., sensitivity and specificity) were estimated and compared for the LFK index and Egger test. The LFK index exhibited consistent higher sensitivity across varying k and simulated bias levels. In contrast, the Egger test was highly dependent on k, with sensitivity declining sharply in small meta-analyses (k < 20). Specificity of the LFK index adjusted with random error, while Egger test specificity remained fixed at ∼90%. The Doi plot and LFK index effectively address the limitations of traditional methods, offering robust k-independent performance and more reliable detection of publication bias. These findings support a transition to the Doi plot and LFK index for publication bias assessment in meta-analyses.

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来源期刊
Journal of Evidence‐Based Medicine
Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
11.20
自引率
1.40%
发文量
42
期刊介绍: The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.
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