Use of L’Abbé and pooled calibration plots to assess the relationship between severity of illness and effectiveness in studies of corticosteroids for.

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Presentation transcript:

Use of L’Abbé and pooled calibration plots to assess the relationship between severity of illness and effectiveness in studies of corticosteroids for severe sepsis K.M. Ho, J.A. Tan British Journal of Anaesthesia Volume 106, Issue 4, Pages 528-536 (April 2011) DOI: 10.1093/bja/aeq417 Copyright © 2011 The Author(s) Terms and Conditions

Fig 1 The L’Abbé plot suggests that there are apparent interactions between an imaginary drug’s treatment effect and severity of illness measured by mortality rates of the placebo groups. A curve parallel to the line of equality signifies lack of interaction between severity of illness and treatment effect. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 2 The calibration plot suggests that the observed mortality of placebo groups are similar to those predicted by a risk prediction model, and that mortality rates of subjects who received an imaginary drug are lower than expected in subjects at high risk of mortality. This suggests that there are apparent interactions between the imaginary drug’s treatment effect and severity of illness. Circles represent the patients in the treatment group and squares represent the patients in the placebo group. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 3 Flow chart showing study inclusion and exclusion criteria. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 4 Forest plot showing the effect of corticosteroids on mortality of subjects with sepsis, severe sepsis, or pneumonia when all included trials were considered. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 5 Meta-regression of mortality rates of the placebo groups on log ORs of the effect of corticosteroids on mortality. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 6 The L’Abbé plot suggests that there is no apparent relationship between the treatment effect of corticosteroids and severity of illness measured by mortality rates of the placebo groups. The size of the symbol is proportional to the size of the trial. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 7 The pooled calibration plot suggests that the observed mortality rates of the placebo groups in three studies and the observed mortality rates of the treatment groups in two studies were higher than predicted. Circles represent the treatment group and squares represent the placebo group of the included studies. Symbol size is proportional to the sample size of the studies. The excessive mortality rates of the placebo groups of three positive studies are highlighted in blue. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 8 Forest plot showing the effect of corticosteroids on mortality of patients with sepsis, severe sepsis, or pneumonia after excluding the three trials with excessive deaths in the placebo groups. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions

Fig 9 Meta-regression of mortality rates of the placebo groups on log ORs of the effect of corticosteroids on mortality after excluding the three studies with higher than expected mortality in the placebo groups. British Journal of Anaesthesia 2011 106, 528-536DOI: (10.1093/bja/aeq417) Copyright © 2011 The Author(s) Terms and Conditions