gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

The ONKO-KISS study on bone marrow and peripheral bloodstem-cell transplantation and the occurrence of hospital-acquiredinfections during neutropenia: essential statistical issues.

Meeting Abstract

  • Jan Beyersmann - Institute of Medical Biometry and Medical Computer Science, University Hospital Freiburg, Germany
  • M. Schumacher - Institute of Medical Biometry and Medical Computer Science, University Hospital Freiburg, Germany
  • M. Dettenkofer - Institute of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Germany

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds039

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2005/05gmds298.shtml

Veröffentlicht: 8. September 2005

© 2005 Beyersmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Bone marrow and peripheral blood stem-cell transplantationshave become a successful therapy for severe hematologicdiseases. However, with transplantation a patient enters a high riskphase, called neutropenia. Occurrence of infectious complications,mostly bloodstream infections or pneumonia, is more likely duringneutropenia, increasing morbidity and mortality. ONKO-KISS is aprospective multi-centre cohort study to provide reference data and toassess risk factors for the occurrence of bloodstream infections andpneumonia during neutropenia [1]. It is part of the surveillance program of the German National Reference Centrefor Surveillance of Nosocomial Infections (KISS - German HospitalInfection Surveillance System; http://www.nrz-hygiene.de/).

A meaningful analysis of the data collected in this study has to judgethe (possibly different) effects a risk factor has on the competingevents `infection', `death' and `end of neutropenia'. Also, the timethese events occur is important. In statistics, this situation isknown as `competing risks' [2]. An adequatehazard-based analysis using the well-known Cox model, say, isfeasible, but interpretationally difficult due to the competingrisks. We illustrate these difficulties and offer an alternativeanalysis using the Fine-Gray model for cumulative incidences [3]. The cumulative incidence function for `infection', say,displays the proportion of patients infected as time progresses. Anexcellent interpretation of our results from the Fine-Gray model canbe achieved displaying these proportions for different constellationsof risk factors.


References

1.
M Dettenkofer, S Wenzler-Röttele, R Babikir, H Bertz, W Ebner, EMeyer, H Rüden, P Gastmeier, FD Daschner: Surveillance of nosocomialsepsis and pneumonia in patients with a bone marrow or peripheralblood stem cell transplant. A multicenter project. ClinicalInfectious Diseases 2005 (40): 926-931
2.
J Klein, J D Rizzo, M-J Zhang, N Keiding. Statistical methods forthe analysis and presentation of the results of bone marrowtransplants. Part~I: Unadjusted analysis. Bone Marrow Transplantation2001 (28): 1001-1011
3.
J Fine, R Gray. A proportional hazards model for thesubdistribution of a competing risk. Journal of the AmericanStatistical Association 1999 (94): 496-509