Statistical methods to study the association between a longitudinal biomarker and the risk of death are very relevant for the long-term care of subjects affected by chronic illnesses, such as potassium in heart failure patients. Particularly in presence of comorbidities or pharmacological treatments, sudden crises can cause potassium to undergo very abrupt yet transient changes. In the context of the monitoring of potassium, there is the need for a dynamic model that can be used in clinical practice to assess the risk of death related to an observed patient's potassium trajectory. We considered different dynamic survival approaches, starting from the simple approach considering the most recent measurement, to the joint model. We then propose a novel method based on wavelet filtering and landmarking to retrieve the prognostic role of short-term potassium oscillations. The data used comes from over 2000 subjects, with a total of over 80 000 repeated potassium measurements collected through Administrative Health Records and Outpatient and Inpatient Clinic E-chart. We claim that while taking into account for past information is important, not all past information is equally informative. Recent, even if short-term changes in potassium contain relevant prognostic information. However, we show that these oscillations are not captured by state-of-the-art dynamic survival models. The latter are prone to give more importance to the mean long-term value of potassium. As a consequence, a novel dynamic survival approach is proposed in this work for the monitoring of potassium in heart failure. The proposed wavelet landmark method shows promising results revealing the prognostic role of short-term oscillations, according to their different duration, and achieving higher performances in predicting survival probability based on potassium over time.
翻译:研究纵向生物标志物与死亡风险之间的关联的统计方法,对于长期护理慢性疾病患者,如心脏病患者中的钾等受慢性疾病影响的病人,非常相关。特别是当出现腐蚀性或药理治疗时,突发危机可能导致钾发生非常突然但短暂的变化。在监测钾方面,需要一种动态模型,用于临床实践,以评估与观察到的病人的钾轨迹有关的死亡风险。我们认为,从考虑最新测量的简单方法开始,到联合模型,不同的动态生存方法都非常相关。然后,我们提出一种基于波盘过滤和里程碑的新方法,以获取短期钾振荡性作用的预测性作用,突然危机可能导致钾发生非常突然而短暂的变化。这些数据来自2000年以上的研究对象,通过行政健康记录和门诊和门诊E图收集了总共80 000多项重复的钾测量。我们声称,考虑到过去的信息很重要,但并非所有以往的信息都同样具有信息。最近,即使短期的变化含有相关的预测性机能性机能性,但最近,由于钾的短期变化含有相关的预感性机能性失常值,因此,我们展示了一种动态性能性观测结果。我们展示的是,这些结果显示,其具有更具有较强的稳定性的稳定性的状态。我们展示性能性能性能性能的状态。我们表明,从这些结果表明,这些结果表明,我们以具有较强性地表明它们具有较强的概率性能性能性能性能性能性能的状态。</s>