Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Potgieter, D; Simmers, D; Ryan, L; Biccard, BM; Lurati-Buse, GA; Cardinale, DM; Chong, CP; Cnotliwy, M; Farzi, SI; Jankovic, RJ; Lim, WK; Mahla, E; Manikandan, R; Oscarsson, A; Phy, MP; Rajagopalan, S; Van Gaal, WJ; Waliszek, M; Rodseth, RN.
N-terminal pro-B-type Natriuretic Peptides' Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds.
Anesthesiology. 2015; 123(2):264-271
Doi: 10.1097/ALN.0000000000000728
Web of Science
PubMed
FullText
FullText_MUG
- Co-authors Med Uni Graz
- Farzi Sylvia Ingrid
- Mahla Elisabeth
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (<100 patients) a single cohort threshold was associated with an OR of 5.4 (95% CI, 2.27 to 12.84) as compared with an OR of 14.38 (95% CI, 6.08 to 34.01) for study-specific thresholds. Post hoc identification of study-specific prognostic biomarker thresholds artificially maximizes biomarker predictive power, resulting in an amplification or overestimation during meta-analysis of these results. This effect is accentuated in small studies.
- Find related publications in this database (using NLM MeSH Indexing)
- Biomarkers - blood
- Heart Diseases - blood
- Heart Diseases - diagnosis
- Humans -
- Natriuretic Peptide, Brain - blood
- Peptide Fragments - blood
- Prognosis -