Kev soj ntsuam rhiab heev
Kev soj ntsuam rhiab heev uas txwv tsis pub muaj kev tshawb fawb rau tsuas yog cov uas qhia txog kev hloov pauv kev phom sij (n{{0}}) thiab tshem tawm cov uas peb tau txais kev phom sij txaus ntshai tau pom pom zoo sib xws (kev phom sij piv 0}.37, { {5}}.31 txog 0.44; Cochran Q statistic 163.65, P<0.01; I2=93.3%, P<0.01). Further restricting the 11 studies to only those in which we did not assume that the provided Cox regression model results were hazard ratios when presented as relative risks (that is, the hazard ratios were explicitly clear; n=6) made no significant change to the result (hazard ratio 0.35, 0.29 to 0.43; Cochran Q statistic 127.26, P<0.01; I2=95.3%, P<0.01).
Nws yuav siv sij hawm ntev npaum li cas rau CISTANCHE ua haujlwm rau cov neeg mob raum?
Txhawm rau ntsuas qhov cuam tshuam rau lub sijhawm, peb suav qhov kev phom sij sib xyaw rau cov kev tshawb fawb nrog qhov nruab nrab ntawm cov ntaub ntawv nrhiav neeg ua haujlwm rau lossis ua ntej xyoo 2000 (n=10; txaus ntshai piv {{10}}.44, 0.28 rau 0.71) thiab tom qab xyoo 2000 (n=7; 0.44, 0.36 txog 0.53), uas tsis pom muaj lub sijhawm tseem ceeb .
Rau qhov kev ntsuam xyuas outlier, peb tau txheeb xyuas tsib qhov kev tshawb fawb raws li outliers thiab thiaj li tshem tawm lawv. Qhov no tsis cuam tshuam rau kev kwv yees (kev phom sij piv {{0}}}.44, 0.39 txog 0.49) thiab qhov cuam tshuam tsis zoo ntawm kev sib raug zoo, uas tseem ceeb heev (Cochran Q txheeb cais 65.31, P<0.001; I2=78.6%). Similarly, leave-one-out analysis showed that no singular study when omitted altered the Qhov tseem ceeb ntawm qhov sib npaug ntawm qhov phom sij lossis txo qis qhov tseem ceeb heterogeneity tam sim no (cov lus ntxiv E). Thaum kawg, peb tsim ib lub phiaj xwm GOSH. Rau tag nrho cov nyhuv loj, peb pom ib qho unimodal faib tawm tswv yim homogeneity nyob rau hauv pooled kwv yees, nrog transplantation muab txo qis kev pheej hmoo ntawm kev tuag piv nrog rau kev lim ntshav tsis hais cov subset ntawm cov kev tshawb fawb xaiv. Txawm li cas los xij, peb pom bimodal faib rau I2 cov txiaj ntsig qhia tias muaj ntau duahomogenous pawg ntawm kev tshawb fawb. Txawm li cas los xij, txawm tias qhov kev pom zoo tshaj plaws ntawm cov kev tshawb fawb tau xaiv rau kev tshuaj ntsuam meta, heterogeneity tseem ceeb ntawm I2 Ntau dua lossis sib npaug rau 70 (daim duab 5).
Meta-regression
Peb tau ua ib qho kev ntsuam xyuas meta-regression los kwv yees cov txiaj ntsig ntawm cov kev tshawb fawb txuas ntxiv xws li lub hnub nyoog nruab nrab, lub sijhawm ntev tshaj plaws ntawm kev soj ntsuam, thiab lub sijhawm nruab nrab ntawm kev sau cov ntaub ntawv. Tsis muaj ib qho ntawm cov no tuaj yeem suav rau tag nrho heterogeneity (cov lus ntxiv F).
Daim duab 4|Cov phiaj xwm hav zoov ntawm kev phom sij sib piv (nrog 95% kev ntseeg siab lub sijhawm (CIs)) rau kev hloov pauv mus rau cov npe hu ua waitlisted dialysis, stratified los ntawm pej xeem hom. lnHR=log hazard ratio; seHR=tus qauv yuam kev txaus ntshai piv
Kev tshaj tawm tsis ncaj ncees
Cov phiaj xwm funnel tau dav symmetrical, thiab qhov no tau lees paub los ntawm qhov tsis tseem ceeb Egger qhov kev sim (0.8821, P=0.46), qhia txog qhov tsis tshua muaj tshwm sim ntawm kev tshaj tawm tsis zoo (cov duab ntxiv A).
Kev sib tham
Qhov kev tshuaj xyuas no tau muab piv rau txhua qhov ua rau kev tuag cuam tshuam nrog kev hloov pauv hloov pauv mus rau kev lim ntshav hauv cov neeg mob tos nrograum tsis ua haujlwm, nrog ntau cov pov thawj qhia tias kev hloov pauv yuav cuam tshuam nrog cov txiaj ntsig tseem ceeb ntawm kev muaj sia nyob piv nrog kev lim ntshav. Txawm li cas los xij, txawm tias tag nrho cov txiaj ntsig ntawm kev hloov pauv rau cov neeg mob lub raum tsis ua haujlwm yog ib qhohomogenous lus, tsom xam rau ntau pawg subyog qhov tsis sib haum xeeb, ua tsis tau qhov tseeb ntawm kev ciaj siatxiaj ntsig ntawmtransplantation piv rau dialysisrau xaivcov pej xeem. Peb qhov kev tshuaj xyuas kuj tau txheeb xyuas qhov tseem ceebheterogeneity nyob rau hauv cov ntaub ntawv luam tawm, uas yogkhaws cia txawm tias ntxiv kev txheeb cais,qhia tias cov ntaub ntawv ntawm cov pej xeem yuav tsum yogcautiously txhais rau tus neeg mob raukev txiav txim siab tus kheej.
Qhov cuam tshuam ntawm kev tshawb pom
Qhov chaw ntawmheterogeneitynyob rau hauv peb txoj kev tshawb fawb muaj peev xwm muaj ntau yam xws li, tab sis tsis txwv rau, thaj chaw thaj chaw, cov txheej txheem kev txheeb cais, hom pub dawb, kev lim ntshav lim ntshav, lub nra hnyav, lub sijhawm them nyiaj, kev tiv thaiv kab mob, kev kho mob, thiab cov kev hloov pauv hauv cov pej xeem. Peb tau sim suav rau qee yam ntawm cov xwm txheej no, tab sis tsis muaj ib qho tseem ceeb. Kev tshaj tawm tsis zoo thiab stratification ntawm cov kev hloov pauv no nyob rau hauv cov kev tshawb fawb muaj txwv tsis pub muaj kev soj ntsuam tob, tab sis kev tswj xyuas cov neeg mob nrograum tsis ua haujlwmua ib tug complex multivariate equation extending tshaj covariates ntsuas yog ntau dua.
Txaus siab tias qhov kev pheej hmoo- txiaj ntsig piv ntawm kev hloov pauv mus rau kev lim ntshav tsis yog kev txiav txim siab ntawm kev muaj sia nyob yog qhov tseem ceeb. Kev cuam tshuam rau lub neej zoo kuj yog ib qho tseem ceeb
kev txiav txim siab nyob rau hauv kev ntsuam xyuas ntawm cov neeg sib tw rauhloov raum.70 Peb txoj hauj lwm muab cov ntaub ntawv tseem ceeb ntawm cov pej xeem los qhia kev tawm tswv yim txog kev muaj sia nyob, tab sis kev txiav txim siab txog kev pheej hmoo rau tus kheej ntawm ib tus neeg yog qhov nyuaj rau kev kho mob.
Txawm hais tias txoj cai tswjfwm ib txwm txhawb nqa kev koom tes ntawm cov neeg mob hauv kev txiav txim siab, kev txiav txim siab Montgomery tau hloov pauv txoj cai lij choj ntawm kev tau txais kev pom zoo hauv cov tebchaws xws li UK.71 Cov txiaj ntsig ntawm tus kheej cov xwm txheej tam sim no yuav tsum raug suav nrog qhov tshwm sim ntawm cov txiaj ntsig. los yog raug mob tshwm sim. Yog li ntawd, txawm peb ntseeg li ntawdpeb qhov systematic tshuaj xyuas ntawm pej xeem cohort kev tshawb fawbyog cov ntaub ntawv qhia txog kev pheej hmoo ntawm cov neeg sib tw rauhloov raum, nws tsuas yog muab kev txhawb nqacov ntaub ntawv rau qhov kev txiav txim tag nrho ntawm tus kheejtxaus ntshai rau cov tib neeg.
Daim duab 5|GOSH zaj duab xis (graphical zaub ntawm heterogeneity) ntawm I2 tiv thaiv cov ntsiab lus ntawm qhov ntau thiab tsawg (log kev phom sij piv) qhia txog kev ntsuas tsis zoo tab sis bimodal heterogeneity qauv. Tsis hais txog kev xaiv kawm, heterogeneity tseem ceeb
Lub zog thiab kev txwv ntawm txoj kev kawm
Qhov no yog qhov kev tshuaj xyuas zoo tshaj plaws txog kev tuag hauv kev hloov pauv mus rau kev lim ntshav thiab thawj zaug tsom rauthawj lub raum hloov pauvtiv thaiv cov neeg sib tw tos, yog li txo qhov kev xaiv tsis ncaj ncees nyob rau hauv kev tshuaj ntsuam xyuas yav dhau los. Peb qhov kev tshuaj xyuas tau ua raws li cov txheej txheem tshuaj xyuas tag nrho, tsis muaj kev txwv ntawm hom lus thiab ob qho tib si
kev tshuaj xyuas cov npe, cov lus piav qhia, cov ntawv sau tag nrho, thiab kev pheej hmoo ntawm kev ntsuam xyuas tsis zoo. Yog li ntawd, peb tuaj yeem txheeb xyuas tsib qhov kev tshawb fawb ntxiv uas tau ploj lawm los ntawm kev tshuaj xyuas yav dhau los los ntawm Tonelli thiab cov npoj yaig thiab 20 cov kev tshawb fawb ntxiv tshiab tshaj tawm tom qab nws. Tsis tas li ntawd, txoj kev tshawb no yog thawj zaug los nthuav qhia meta-kev tshuaj xyuas ntawm lub sijhawm-rau-kev tshwm sim cov ntaub ntawv los ntawm Cochrane
Phau Ntawv Qhia Txog Kev Tshawb Fawb Txog Kev Pabcuam.
Cov kev txwv ntawm txoj haujlwm no tsim nyog sau cia. Ua ntej, muaj ntau yam heterogeneity muaj nyob rau hauv cov ntaub ntawv luam tawm, uas tsis tuaj yeem suav nrog txawm tias tsim nyog cov txheej txheem kev tshuaj xyuas. Qhov thib ob, thaum tsis muaj cov kev tshawb fawb qhia txog kev hloov pauv kev phom sij nrog kev kwv yees qhov tseeb, peb suav nrog cov kev tshawb fawb uas tau tshaj tawm Kaplan-Meier nkhaus siv lub palmar
cov txheej txheem los ntawm extrapolating txaus ntshai piv raws li qhov tsawg kawg nkaus thiab siab tshaj lub sij hawm taug qab thiab cov qauv censoring. Txawm li cas los xij, digitalization thiab extrapolation ntawm kev phom sij piv los ntawm Kaplan-Meier nkhaus tuaj yeem muaj teeb meem ntawm kev rov tsim dua thiab tsis raug. Txawm li cas los xij, kev soj ntsuam rhiab heev nrog kev cais tawm ntawm cov kev tshawb fawb no pom tsis muaj kev cuam tshuam tseem ceeb. Thib peb, peb suav nrog cov kev tshawb fawb ntau xyoo dhau los (1977-2021), thaum lub sijhawm kev hloov pauv thiab lim ntshav tseem ceeb. Txawm li cas los, rhiab heev tsom xam
for earlier and more recent studies (>2000 thiab Tsawg dua los yog sib npaug rau 2000) tau qhia tias qhov kev kwv yees ntawm cov ntsiab lus tau zoo sib xws, thiab meta-regression tsis pom muaj qhov cuam tshuam tseem ceeb ntawm lub sijhawm. Thib plaub, peb suav tias kev tuag mus ntev yog qhov txaus ntshai tom qab ib xyoos; qhov no encapsulates ntau lub sijhawm sib txawv ntawm lub sijhawm thiab txwv kev txhais cov ntaub ntawv. Txawm li cas los xij, ntawm GOSH cov phiaj xwm kev tsim kho, kev faib tawm tsis zoo
tau pom rau qhov loj me, qhia qhov sib xws thoob plaws cov kev tshawb fawb tsis hais seb qhov twg tau raug xaiv. Qhov loj I2 tus nqi (95.3%) qhia tau hais tias muaj ntau yam kev kwv yees qhov kev pheej hmoo, tab sis peb pom tsis muaj pov thawj hauv kev tshuaj xyuas kev lim ntshav muab kev muaj sia nyob ntev dua li kev hloov pauv-qhov zoo tshaj plaws, kev pheej hmoo sib npaug tau tshaj tawm. Thaum kawg, peb txoj kev tshawb fawb tsuas yog tshawb nrhiav cov txiaj ntsig ntawm kev tuag, thiab lwm yam kev soj ntsuam cov neeg mob tau tshaj tawm cov txiaj ntsig xws li kev ua neej zoo lossis kev noj qab haus huv sib txawv yog dhau qhov kev ua haujlwm no.
Cov lus xaus
Txhawm rau xaus, cov pov thawj los ntawm peb qhov kev tshuaj xyuas ntau dhau pom tau tias kev hloov pauv tau cuam tshuam nrog kev txo qis hauv kev pheej hmoo tuag mus ntev piv nrog rau qhov seem ntawm kev lim ntshav rau cov neeg mob lub raum tsis ua haujlwm. Txawm hais tias muaj kev kwv yees tsis sib xws ntawm kev pheej hmoo tuag, qhov tseem ceeb heterogeneity muaj nyob nruab nrab ntawm cov kev tshawb fawb uas txwv tsis pub siv sab nraud, tshwj xeeb tshaj yog rau cov pawg neeg xaiv xws li cov neeg sib tw laus lossis kev txiav txim siab tus kheej. Yog li ntawd, txawm hais tias peb tuaj yeem ntseeg siab tias kev hloov pauv yog qhov kev xaiv rau cov neeg mob
nrograum tsis ua haujlwm, txiav txim siab pab pawg neeg ntawm cov neeg mob nyob rau hauv uas kev hloov pauv tau yooj yim rau kev siv hluav taws xob loj tshaj plaws tseem nyuaj thiab xav tau kev tshawb nrhiav ntxiv.
Cov neeg koom nrog:
DC thiab AS tsim qhov kev kawm. DC, JP, thiab AS tau npaj qhov kev txheeb xyuas kev txheeb xyuas. DC thiab AC txheeb xyuas thiab rho tawm cov ntaub ntawv, nrog kev pab los ntawm JP. DC thiab AC soj ntsuam kev kawm tsim nyog thiab zoo. JP thiab AS tau saib xyuas cov txheej txheem tshuaj xyuas thiab sib koom lub luag haujlwm rau coding kev cuam tshuam ncaj qha thiab tsis ncaj. DC thiab AS tau sau thawj tsab ntawv ntawm cov ntawv sau. Txhua tus kws sau ntawv tau pab txhawb rau kev txhais lus thiab kev hloov kho tom ntej ntawm cov ntawv sau. AS yog tus lav. Tus kws sau ntawv tau lees paub tias txhua tus sau sau npe ua tau raws li cov txheej txheem sau ntawv thiab tsis muaj lwm tus ua tau raws li cov txheej txheem tau raug tshem tawm. Cov Nyiaj Txiag: DC tau txais kev txhawb nqa los ntawm Royal College of Surgeons (England)
pub. Tus neeg nrhiav nyiaj txiag tsis muaj lub luag haujlwm hauv kev tsim qauv, kev tuav ntaub ntawv, lossis sau daim ntawv tshaj tawm. Tus kws sau ntawv tau nkag mus rau tag nrho cov ntaub ntawv hauv txoj kev tshawb fawb thiab muaj lub luag haujlwm kawg rau kev txiav txim siab xa mus rau kev tshaj tawm.
1 UK Renal Renal Registry. UK Renal Registry 23rd Annual Report: cov ntaub ntawv rau 31/12/2019. 2021. renal.org/audit-research/annual-report.
2 NHS Ntshav thiab Hloov. Lub cev thiab cov ntaub so ntswg pub dawb thiab hloov pauv: Daim Ntawv Qhia Txog Kev Ua Haujlwm 2020/21. 2021.https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/24053/activityreport-2020-2021.pdf.
3 Tonelli M, Wiebe N, Knoll G, et al. Kev tshuaj xyuas Systematic: hloov lub raum piv nrog rau kev lim ntshav hauv cov txiaj ntsig kho mob. Am J Hloov 2011;11:2093-109. doi:10.1111/j.1600-6143.2011.03686.x
4 Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Cov ntawv tshaj tawm nyiam tshaj plaws rau kev tshuaj xyuas thiab kev tshuaj ntsuam xyuas meta: PRISMA nqe lus. PLoS Med 2009; 6:e1000097. doi: 10.1371/ journal.pmed.1000097
5 Magee JC, Barr ML, Basadonna GP, et al. Rov ua dua lub cev hloov pauv hauv Tebchaws Meskas, 1996-2005. Am J Hloov 2007;7:1424-33. doi:10.1111/j.1600-6143.2007.01786.x
6 Summers DM, Johnson RJ, Allen J, et al. Kev tshuaj xyuas ntawm yam uas cuam tshuam rau cov txiaj ntsig tom qab hloov lub raum pub dawb tom qab lub plawv tuag hauv UK: kev tshawb fawb sib koom ua ke. Lancet 2010; 376:1303-11. doi:10.1016/S0140-6736(10)60827-6
7 Wells GA, Shea B, O'Connell D, et al. Newcastle-Ottawa Scale (NOS) rau kev ntsuam xyuas qhov zoo ntawm cov kev tshawb fawb tsis sib xws hauv kev tshuaj ntsuam meta. 2000. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
8 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological zoo (kev pheej hmoo ntawm kev tsis ncaj ncees) cov cuab yeej ntsuas rau kev tshawb fawb kev kho mob thawj zaug thiab theem nrab: lawv yog dab tsi thiab qhov twg zoo dua?Mil Med Res 2020; 7: 7. doi: 10.1186/s40779-020-00238-8
9 Castillo JJ, Dalia S, Shum H. Meta-kev tshuaj xyuas ntawm kev sib koom ua ke ntawm kev haus luam yeeb thiab qhov tshwm sim ntawm Hodgkin's Lymphoma. J Clin Oncol 2011; 29:3900-6. doi: 10.1200/JCO.2011.35.4449
10 Higgins JPT, Li T, Deeks JJ. Tshooj 6. Xaiv cov kev ntsuas cuam tshuam thiab suav cov kwv yees cov txiaj ntsig. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. Cochrane Phau Ntawv Qhia Txog Kev Tshawb Fawb Txog Kev Ua Haujlwm. 2nd tsab. John Wiley & Tub, 2019.
11 Parmar MKB, Torri V, Stewart L. Extracting summary statistics to do meta-analyses of the published literature for survival endpoints. Stat Med 1998; 17:2815-34. doi:10.1002/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8
12 Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Cov tswv yim tswv yim rau kev koom ua ke cov ntsiab lus lub sij hawm-rau-kev tshwm sim cov ntaub ntawv rau hauv meta-analysis. Phau Ntawv Nkauj 2007; 8:16. doi: 10.1186/1745-6215-8-16
13 Bormann I. DigitizeIt software, version 2.5. Braunschweig, Lub teb chaws Yelemees. 2012.
