دورية أكاديمية
Causal Bayesian machine learning to assess treatment effect heterogeneity by dexamethasone dose for patients with COVID-19 and severe hypoxemia.
| العنوان: | Causal Bayesian machine learning to assess treatment effect heterogeneity by dexamethasone dose for patients with COVID-19 and severe hypoxemia. |
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| المؤلفون: | Blette BS; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.; Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Granholm A; Department of Intensive Care, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.; Collaboration for Research in Intensive Care, Copenhagen, Denmark., Li F; Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA.; Center for Methods in Implementation and Prevention Science, Yale University School of Public Health, New Haven, CT, USA., Shankar-Hari M; Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK., Lange T; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Munch MW; Department of Intensive Care, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.; Collaboration for Research in Intensive Care, Copenhagen, Denmark., Møller MH; Department of Intensive Care, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.; Collaboration for Research in Intensive Care, Copenhagen, Denmark., Perner A; Department of Intensive Care, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.; Collaboration for Research in Intensive Care, Copenhagen, Denmark., Harhay MO; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. mharhay@pennmedicine.upenn.edu.; Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. mharhay@pennmedicine.upenn.edu.; Division of Pulmonary and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 304 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA. mharhay@pennmedicine.upenn.edu. |
| المصدر: | Scientific reports [Sci Rep] 2023 Apr 21; Vol. 13 (1), pp. 6570. Date of Electronic Publication: 2023 Apr 21. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : Nature Publishing Group, copyright 2011- |
| مواضيع طبية MeSH: | COVID-19*, Humans ; SARS-CoV-2 ; Bayes Theorem ; COVID-19 Drug Treatment ; Dexamethasone/therapeutic use ; Hypoxia |
| مستخلص: | The currently recommended dose of dexamethasone for patients with severe or critical COVID-19 is 6 mg per day (mg/d) regardless of patient features and variation. However, patients with severe or critical COVID-19 are heterogenous in many ways (e.g., age, weight, comorbidities, disease severity, and immune features). Thus, it is conceivable that a standardized dosing protocol may not be optimal. We assessed treatment effect heterogeneity in the COVID STEROID 2 trial, which compared 6 mg/d to 12 mg/d, using a causal inference framework with Bayesian Additive Regression Trees, a flexible modeling method that detects interactive effects and nonlinear relationships among multiple patient characteristics simultaneously. We found that 12 mg/d of dexamethasone, relative to 6 mg/d, was probably associated with better long-term outcomes (days alive without life support and mortality after 90 days) among the entire trial population (i.e., no signals of harm), and probably more beneficial among those without diabetes mellitus, that were older, were not using IL-6 inhibitors at baseline, weighed less, or had higher level respiratory support at baseline. This adds more evidence supporting the use of 12 mg/d in practice for most patients not receiving other immunosuppressants and that additional study of dosing could potentially optimize clinical outcomes. (© 2023. The Author(s).) |
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| معلومات مُعتمدة: | R00 HL141678 United States HL NHLBI NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS; CS-2016-16-011 United Kingdom DH_ Department of Health; R01 HL126802 United States HL NHLBI NIH HHS |
| المشرفين على المادة: | 7S5I7G3JQL (Dexamethasone) |
| تواريخ الأحداث: | Date Created: 20230421 Date Completed: 20230425 Latest Revision: 20240315 |
| رمز التحديث: | 20240315 |
| مُعرف محوري في PubMed: | PMC10120498 |
| DOI: | 10.1038/s41598-023-33425-3 |
| PMID: | 37085591 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 2045-2322 |
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| DOI: | 10.1038/s41598-023-33425-3 |