Rationales, Methods and Challenges of Using GRADE in Systematic Review of Prognostic Studies_Chinese Journal of Evidence-Based Medicine

Authors：

YANGNan ¹ , DENGWei ² , CHENYao-long ^3,4,5 , YAOLiang ^3,4,5 , WANGQi ^3,4,5 , WEIDang ^3,4,5 , WANGXiao-qin ^3,4,5 , FUSi-qi ² , LIRui ² ,  YANGKe-hu ^3,4,5

1. The First Medicine School, Lanzhou University, Lanzhou 730000, China;
2. The Second Medicine School, Lanzhou University, Lanzhou 730000, China;
3. Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China;
4. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China;
5. Chinese GRADE Center, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

YANGKe-hu, Email: yangkh@lzu.edu.cn

Keywords：

GRADE; Prognostic study; Systematic review; Quality of evidence

DOI：

10.7507/1672-2531.20150184

Video：

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The methodology of conducting systematic review of prognostic studies has received a great deal of interest in recent years. Using GRADE for systematic review of prognostic studies, five aspects should be considered:risk of bias, indirectness, inconsistency, imprecision and publication bias. The methods of using GRADE system in systematic review of prognostic studies are similar to systematic review of interventional studies, meanwhile, there are differences. Not only the uniqueness of prognostic study but also the repeating downgrade should be taken into consideration in the GRADE process. Applying GRADE to systematic review of prognostic studies would be widely accepted along with the methodology development and quality improvement of systematic review of prognostic studies.

Citation： YANGNan, DENGWei, CHENYao-long, YAOLiang, WANGQi, WEIDang, WANGXiao-qin, FUSi-qi, LIRui, YANGKe-hu. Rationales, Methods and Challenges of Using GRADE in Systematic Review of Prognostic Studies. Chinese Journal of Evidence-Based Medicine, 2015, 15(9): 1112-1116. doi: 10.7507/1672-2531.20150184 Copy

1.	Altman DG. Systematic reviews of evaluations of prognostic variables. BMJ, 2001, 323(7306):224-228.
2.	蔺莉, 张煦, 崔杰, 等. 70例弥漫大B细胞淋巴瘤的预后分析. 兰州大学学报(医学版), 2010, 36(1):74-77.
3.	田尤新, 张建伟. 甲状腺癌组织中微血管形成与预后指数关系. 兰州大学学报(医学版), 2009, 35(1):32-34.
4.	李强, 郭庆红, 路红, 等. 胃癌Smad4、CyclinD1和P21waf1表达意义及其与生存的关系. 兰州大学学报(医学版), 2011, 37(1):25-30.
5.	Riley RD, Hayden JA, Steyerberg EW, et al. Prognosis Research Strategy (PROGRESS)2:Prognostic Factor Research. PLoS Med, 2013, 10(2):e1001380.
6.	Hemingway H, Croft P, Perel P, et al. Prognosis research strategy (PROGRESS)1:A framework for researching clinical outcomes. BMJ, 2013, 346(fed05 1):e5595-e5595.
7.	Hingorania D, Windt D, Riley RD, et al. Prognosis research strategy (PROGRESS)4:Stratified medicine research. BMJ. 2013, 346(fed 5):e5793-e5793.
8.	Steyerberg EW, Moons KGM, van der Windt DA, et al. Prognosis research strategy (PROGRESS)3:Prognostic Model Research. PLoS Med, 2013, 10(2):e1001381.
9.	陈耀龙, 姚亮, 杜亮, 等. GRADE在诊断准确性试验系统评价中应用的原理、方法、挑战及发展趋势. 中国循证医学杂志, 2014, 14(11):1402-1406.
10.	姚亮, 陈耀龙, 杜亮, 等. GRADE在诊断准确性试验系统评价中应用的实例解析. 中国循证医学杂志, 2014, 14(11):1407-1412.
11.	陈耀龙, 姚亮, 杜亮, 等. GRADE 在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12):1401-1404.
12.	Iorio A, Spencer FA, Falavigna M, et al. Use of GRADE for assessment of evidence about prognosis:rating confidence in estimates of event rates in broad categories of patients. BMJ, 2015, 16(350):h870.
13.	Lopes LC, Spencer Fa, Neumann I, et al. Bleeding risk in atrial fibrillation patients taking vitamin K antagonists:Systematic review and meta-analysis. Clin Pharmacol Ther, 2013, 94(3):367-375.
14.	Hayden J, van der Windt D, Cartwright JL, et al. Assessing bias in studies of prognostic factors. Ann Intern Med, 2013, 158(4):280-286.
15.	Busse JW, Guyatt GH. Tool to Assess Risk of Bias in Case Control Studies[Internet]. Available at:http://distillercer.com/resources/methodological-resources/risk-of-bias-in-case-control-studies/.
16.	Reeves BC, Deeks JJ, Higgins JP, et al. Including non-randomized studies. In:Higgins JP, Green s, editors. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2010, 391-432.
17.	Arcelus J, Mitchell AJ, Wales J, et al. Mortality rates in patients with anorexia nervosa and other eating disorder. A meta-analysis of 36 studies. Arch Gen Psychiatry, 2011, 68(7):724-731.
18.	Januel JM, Chen G, Riffieux C, et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients. JAMA, 2012, 307(3):294-303.
19.	Su Y, Norris JL, Zang C, et al. Incidence of hepatitis C virus infection in patients on hemodialysis:A systematic review and meta-analysis. Hemodial Int, 2013, 17(4):532-541.
20.	Bukh J, Wantzin P, Krogsgaard K, et al. High prevalence of hepatitis c virus (hcv) rna in dialysis patients:failure of commercially available antibody tests to identify a significant number of patients with HCV infection. J Infect Dis, 1993, 168(6):1343-1348.
21.	Courouce A, Marrec N, Girault A, et al. Anti-hepatitis C Virus (anti-HCV) seroconversion in patients undergoing hemodialysis:comparison of second- and third-generation anti-HCV assays. Transfusion, 1994, 34(9):790-795.
22.	Mohan KM, Wolfe CD, Rudd AG, et al. Risk and cumulative risk of stroke recurrence:a systematic review and meta-analysis. Stroke, 2011, 42(5):1489-1494.
23.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines:7. Rating the quality of evidence——inconsistency. J Clin Epidemiol, 2011, 64(12):1294-1302.
24.	Rücker G, Schwarzer G, Carpenter JR, et al. Undue reliance on I² in assessing heterogeneity may mislead. BMC Med Res Methodol, 2008, 8(1):79.
25.	Yousef F, Cardwell C, Cantwell MM, et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus:a systematic review and meta-analysis. Am J Epidemiol, 2008, 168(3):237-249.
26.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109):629-634.
27.	Begg C, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4):1088-1091.
28.	王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循征医学杂志, 2009, 9(10):1115-1118.

1. Altman DG. Systematic reviews of evaluations of prognostic variables. BMJ, 2001, 323(7306):224-228.
2. 蔺莉, 张煦, 崔杰, 等. 70例弥漫大B细胞淋巴瘤的预后分析. 兰州大学学报(医学版), 2010, 36(1):74-77.
3. 田尤新, 张建伟. 甲状腺癌组织中微血管形成与预后指数关系. 兰州大学学报(医学版), 2009, 35(1):32-34.
4. 李强, 郭庆红, 路红, 等. 胃癌Smad4、CyclinD1和P21waf1表达意义及其与生存的关系. 兰州大学学报(医学版), 2011, 37(1):25-30.
5. Riley RD, Hayden JA, Steyerberg EW, et al. Prognosis Research Strategy (PROGRESS)2:Prognostic Factor Research. PLoS Med, 2013, 10(2):e1001380.
6. Hemingway H, Croft P, Perel P, et al. Prognosis research strategy (PROGRESS)1:A framework for researching clinical outcomes. BMJ, 2013, 346(fed05 1):e5595-e5595.
7. Hingorania D, Windt D, Riley RD, et al. Prognosis research strategy (PROGRESS)4:Stratified medicine research. BMJ. 2013, 346(fed 5):e5793-e5793.
8. Steyerberg EW, Moons KGM, van der Windt DA, et al. Prognosis research strategy (PROGRESS)3:Prognostic Model Research. PLoS Med, 2013, 10(2):e1001381.
9. 陈耀龙, 姚亮, 杜亮, 等. GRADE在诊断准确性试验系统评价中应用的原理、方法、挑战及发展趋势. 中国循证医学杂志, 2014, 14(11):1402-1406.
10. 姚亮, 陈耀龙, 杜亮, 等. GRADE在诊断准确性试验系统评价中应用的实例解析. 中国循证医学杂志, 2014, 14(11):1407-1412.
11. 陈耀龙, 姚亮, 杜亮, 等. GRADE 在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12):1401-1404.
12. Iorio A, Spencer FA, Falavigna M, et al. Use of GRADE for assessment of evidence about prognosis:rating confidence in estimates of event rates in broad categories of patients. BMJ, 2015, 16(350):h870.
13. Lopes LC, Spencer Fa, Neumann I, et al. Bleeding risk in atrial fibrillation patients taking vitamin K antagonists:Systematic review and meta-analysis. Clin Pharmacol Ther, 2013, 94(3):367-375.
14. Hayden J, van der Windt D, Cartwright JL, et al. Assessing bias in studies of prognostic factors. Ann Intern Med, 2013, 158(4):280-286.
15. Busse JW, Guyatt GH. Tool to Assess Risk of Bias in Case Control Studies[Internet]. Available at:http://distillercer.com/resources/methodological-resources/risk-of-bias-in-case-control-studies/.
16. Reeves BC, Deeks JJ, Higgins JP, et al. Including non-randomized studies. In:Higgins JP, Green s, editors. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2010, 391-432.
17. Arcelus J, Mitchell AJ, Wales J, et al. Mortality rates in patients with anorexia nervosa and other eating disorder. A meta-analysis of 36 studies. Arch Gen Psychiatry, 2011, 68(7):724-731.
18. Januel JM, Chen G, Riffieux C, et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients. JAMA, 2012, 307(3):294-303.
19. Su Y, Norris JL, Zang C, et al. Incidence of hepatitis C virus infection in patients on hemodialysis:A systematic review and meta-analysis. Hemodial Int, 2013, 17(4):532-541.
20. Bukh J, Wantzin P, Krogsgaard K, et al. High prevalence of hepatitis c virus (hcv) rna in dialysis patients:failure of commercially available antibody tests to identify a significant number of patients with HCV infection. J Infect Dis, 1993, 168(6):1343-1348.
21. Courouce A, Marrec N, Girault A, et al. Anti-hepatitis C Virus (anti-HCV) seroconversion in patients undergoing hemodialysis:comparison of second- and third-generation anti-HCV assays. Transfusion, 1994, 34(9):790-795.
22. Mohan KM, Wolfe CD, Rudd AG, et al. Risk and cumulative risk of stroke recurrence:a systematic review and meta-analysis. Stroke, 2011, 42(5):1489-1494.
23. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines:7. Rating the quality of evidence——inconsistency. J Clin Epidemiol, 2011, 64(12):1294-1302.
24. Rücker G, Schwarzer G, Carpenter JR, et al. Undue reliance on I² in assessing heterogeneity may mislead. BMC Med Res Methodol, 2008, 8(1):79.
25. Yousef F, Cardwell C, Cantwell MM, et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus:a systematic review and meta-analysis. Am J Epidemiol, 2008, 168(3):237-249.
26. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109):629-634.
27. Begg C, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4):1088-1091.
28. 王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循征医学杂志, 2009, 9(10):1115-1118.

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