GRADE在预后研究系统评价中应用的原理、方法及挑战

Rationales, Methods and Challenges of Using GRADE in Systematic Review of Prognostic Studies

近年来预后研究系统评价方法逐渐受到重视。GRADE对预后研究系统评价的证据分级主要是考虑5个方面:偏倚风险、不直接性、不一致性、不精确性和发表偏倚。GRADE在预后研究系统评价中的分级方法与在干预性系统评价中的应用既存在一定相似性又有较大差异,分级过程中既要考虑预后研究设计的独特性还要避免重复降级。随着预后研究系统评价方法的不断成熟,以及研究质量的逐步提高,GRADE在预后研究系统评价中的运用将会逐渐普及和成熟。

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.