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A modified partial likelihood score method for Cox regression with covariate error under the internal validation design.

ABSTRACT: We develop a new method for covariate error correction in the Cox survival regression model, given a modest sample of internal validation data. Unlike most previous methods for this setting, our method can handle covariate error of arbitrary form. Asymptotic properties of the estimator are derived. In a simulation study, the method was found to perform very well in terms of bias reduction and confidence interval coverage. The method is applied to data from the Health Professionals Follow-Up Study (HPFS) on the effect of diet on incidence of Type II diabetes.

SUBMITTER: Zucker DM

PROVIDER: S-EPMC6555694 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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A modified partial likelihood score method for Cox regression with covariate error under the internal validation design.

Zucker David M DM Zhou Xin X Liao Xiaomei X Li Yi Y Spiegelman Donna D

Biometrics 20190413 2

We develop a new method for covariate error correction in the Cox survival regression model, given a modest sample of internal validation data. Unlike most previous methods for this setting, our method can handle covariate error of arbitrary form. Asymptotic properties of the estimator are derived. In a simulation study, the method was found to perform very well in terms of bias reduction and confidence interval coverage. The method is applied to data from the Health Professionals Follow-Up Stud ...[more]

PMID: 30525191

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Project description:BackgroundThe Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score.MethodsWe developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock.ResultsWe identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%).ConclusionsAmong ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.

Dataset Information

A modified partial likelihood score method for Cox regression with covariate error under the internal validation design.

Publications

A modified partial likelihood score method for Cox regression with covariate error under the internal validation design.

Similar Datasets

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