Developing points-based risk-scoring systems in the presence of competing risks

作者：Austin Peter C^*; Lee Douglas S; D'Agostino Ralph B; Fine Jason P

来源：Statistics in Medicine, 2016, 35(22): 4056-4072.

DOI：10.1002/sim.6994

• survival analysis
• competing risks
• Cox proportional hazards model
• clinical prediction models
• risk-scoring systems

Predicting the occurrence of an adverse event over time is an important issue in clinical medicine. Clinical prediction models and associated points-based risk-scoring systems are popular statistical methods for summarizing the relationship between a multivariable set of patient risk factors and the risk of the occurrence of an adverse event. Points-based risk-scoring systems are popular amongst physicians as they permit a rapid assessment of patient risk without the use of computers or other electronic devices. The use of such points-based risk-scoring systems facilitates evidence-based clinical decision making. There is a growing interest in cause-specific mortality and in non-fatal outcomes. However, when considering these types of outcomes, one must account for competing risks whose occurrence precludes the occurrence of the event of interest. We describe how points-based risk-scoring systems can be developed in the presence of competing events. We illustrate the application of these methods by developing risk-scoring systems for predicting cardiovascular mortality in patients hospitalized with acute myocardial infarction. Code in the R statistical programming language is provided for the implementation of the described methods.

• 出版日期2016-9-30