Prognosis and prediction of antibiotic benefit in adults with clinically diagnosed acute rhinosinusitis: an individual participant data meta-analysis

Diagnostic and Prognostic Research

Research

Daniel Merenstein¹  Helena Liira²  Laurent Kaiser³  An I. de Sutter⁴  Heiner C. Bucher⁵  Karel G. M. Moons⁶  Roderick P. Venekamp⁶  Johannes B. Reitsma⁶  Maarten van Smeden⁶  Jeroen Hoogland⁷  Toshihiko Takada⁸  Paul Little⁹  Maroeska M. Rovers^1,10 

[1] Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA;Department of General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia;Department of General Practice and Primary Care, University of Helsinki, Helsinki, Finland;Department of Medicine, Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland;Department of Public Health and Primary Care, Ghent University, Ghent, Belgium;Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam University, Amsterdam, The Netherlands;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan;Primary Care & Population Sciences Unit, Aldermoor Health Centre, University of Southampton, Southampton, UK;Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands;

关键词: Individual participant data meta-analysis;    Randomized controlled trial;    Acute rhinosinusitis;    Antibiotic treatment;    Individualized treatment effect;    Prediction;   

DOI  :  10.1186/s41512-023-00154-0

 received in 2023-02-21, accepted in 2023-07-20,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundA previous individual participant data meta-analysis (IPD-MA) of antibiotics for adults with clinically diagnosed acute rhinosinusitis (ARS) showed a marginal overall effect of antibiotics, but was unable to identify patients that are most likely to benefit from antibiotics when applying conventional (i.e. univariable or one-variable-at-a-time) subgroup analysis. We updated the systematic review and investigated whether multivariable prediction of patient-level prognosis and antibiotic treatment effect may lead to more tailored treatment assignment in adults presenting to primary care with ARS.MethodsAn IPD-MA of nine double-blind placebo-controlled trials of antibiotic treatment (n=2539) was conducted, with the probability of being cured at 8–15 days as the primary outcome. A logistic mixed effects model was developed to predict the probability of being cured based on demographic characteristics, signs and symptoms, and antibiotic treatment assignment. Predictive performance was quantified based on internal-external cross-validation in terms of calibration and discrimination performance, overall model fit, and the accuracy of individual predictions.ResultsResults indicate that the prognosis with respect to risk of cure could not be reliably predicted (c-statistic 0.58 and Brier score 0.24). Similarly, patient-level treatment effect predictions did not reliably distinguish between those that did and did not benefit from antibiotics (c-for-benefit 0.50).ConclusionsIn conclusion, multivariable prediction based on patient demographics and common signs and symptoms did not reliably predict the patient-level probability of cure and antibiotic effect in this IPD-MA. Therefore, these characteristics cannot be expected to reliably distinguish those that do and do not benefit from antibiotics in adults presenting to primary care with ARS.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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