脆性指数发现儿科学领域的Meta分析的稳健性可能不足

Robustness assessment of pediatrics meta-analysis using fragility index

脆性指数评估儿科学Meta分析的稳健性

Author: ZHANG Ruj, XlA Mingxin, WU Jingting, RUl Xiaoya, XU Chang

Source: Chinese Journal of Evidence-Based Medicine

DOI: 10.7507/1672-2531.202405017

Abstract

Objective To evaluate the robustness of pediatrics clinical evidence-based evidence using fragility index and to explore the factors influencing fragility index.

Methods We searched the PubMed, Embase, and Scopus databases to collect relevant literature on systematic reviews and meta-analyses in the field of pediatrics, and calculated the fragility index. The rank sum test was used to compare differences between groups with different outcome types, different levels of statistical significance, and different sample sizes. Spearman correlation analysis was used to explore the association between the fragility index and sample size, as well as the year of publication.

Results A total of 152 systematic reviews, including 573 meta-analyses, were included, with a median fragility index of 6 (3, 10). Most meta-analyses chose the risk ratio (RR) as the effect measure (387/573, 67.5%), the Mantel-Haenszel method (412/573, 71.9%) as the synthesis method, and the fixed-effect model (300/573, 57.4%) as the assumed model. The Mann-Whitney test showed no statistically significant difference in the fragility index between meta-analyses with safety outcomes and those with efficacy outcomes (P=0.397), and no statistically significant difference between meta-analyses with significant results and those with non-significant results (P=0.520). The Kruskal-Wallis test found a statistically significant difference in sample size among groups with different fragility indices (P<0.001). Spearman correlation analysis found a positive correlation between the fragility index and sample size (ρ=0.39, P<0.001), but no statistically significant correlation with the year of publication (P=0.235).

Conclusion The fragility index of systematic review and meta-analysis published in pediatrics journals is generally low, and the robustness of the results is not high, so it is necessary to be cautious when making evidence-based decisions. Furthermore, the larger the sample size included in the meta-analysis, the higher the fragility index, and incorporating more trials and populations can facilitate the increase in the robustness of the meta-analysis results.

Keywords: Fragility index; Pediatrics; Systematic review; Meta-analysis; Robustness

摘要

目的：使用脆性指数（FI）评估儿科学领域系统评价和 Meta 分析的稳健性并探讨 FI 的影响因素。

方法：计算机检索 PubMed、Embase 及 Scopus 数据库，收集儿科学领域系统评价和 Meta 分析相关文献，计算FI；通过秩和检验比较不同结局类型、不同统计学意义组、不同样本量的组间差异；通过 Spearman 相关性分析探索 FI 与样本量、发表年份的关联。

结果 共纳入 152 项系统评价，包括 573 个 Meta 分析，中位 FI 为 6（3，10）。多数 Meta 分析选择相对危险度（RR）作为效应指标（387/573，67.5%），选择 Mantel-Haenszel 方法（412/573，71.9%）作为合成方法，选择固定效应模型（300/573，57.4%）作为假设模型；Mann-Whitney 检验显示安全性结局的Meta分析的 FI 与有效性结局的 FI 无统计学差异（P=0.397），结果具有统计学意义的 Meta 分析的 FI 与无统计学意义的 Meta 分析的 FI 无统计学差异（P=0.520），Kruskal-Wallis 检验发现不同 FI 的样本量大小的差异有统计学意义（P<0.001）；Spearman 相关性分析发现 FI 与样本量（ρ=0.39，P<0.001）呈正相关关系，与发表年份的相关性无统计学意义（P=0.235）。

结论：发表在儿科学期刊的系统评价和 Meta 分析的 FI 普遍较低，结果的稳健性不高，在进行循证决策时需谨慎。同时，Meta 分析纳入的样本量越大，FI 越大，纳入更多试验和人群能够增加Meta 分析结果的稳健性。

关键词：脆性指数；儿科学；系统评价；Meta 分析；稳健性