| アブストラクト | OBJECTIVES: The ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual's risk of primary THR and TKR in patients newly presenting to primary care. METHODS: We identified two cohorts of patients aged >/=40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free 'Record-Wide Association Study' with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal-external cross-validation (IECV) was then applied over geographical regions to validate two models. RESULTS: 45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70-0.74 (THR model) and 0.76-0.82 (TKR model); the IECV calibration slope ranged between 0.93-1.07 (THR model) and 0.92-1.12 (TKR model). CONCLUSIONS: Two prediction models with good discrimination and calibration that estimate individuals' risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records. |
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| ジャーナル名 | Annals of the rheumatic diseases |
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| 投稿日 | 2018/10/20 |
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| 投稿者 | Yu, Dahai; Jordan, Kelvin P; Snell, Kym I E; Riley, Richard D; Bedson, John; Edwards, John James; Mallen, Christian D; Tan, Valerie; Ukachukwu, Vincent; Prieto-Alhambra, Daniel; Walker, Christine; Peat, George |
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| 組織名 | Arthritis Research UK Primary Care Centre, Research Institute for Primary Care &;Health Sciences, Keele University, Keele, UK d.yu@keele.ac.uk.;Health Sciences, Keele University, Keele, UK.;Centre for Prognostic Research, Arthritis Research UK Primary Care Centre,;Research Institute for Primary Care & Health Sciences, Keele University, Keele,;UK.;GREMPAL (Grup de Recerca en Epidemiologia de les Malalties Prevalents de;l'Aparell Locomotor), Idiap Jordi Gol Primary Care Research Institute and;CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III,;Barcelona, Spain.;Musculoskeletal Pharmaco- and Device Epidemiology - Centre for Statistics in;Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal;Sciences, University of Oxford, Oxford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30337425/ |
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