Abstract
Competing risks hamper the occurrence of other clinically relevant events or modify the probability that they occur, therefore altering the correspondence between rate and risk for the outcome of interest. When the correspondence between rate and risk is lost, the Kaplan-Meier estimator provides systematically upward biased estimates of the risk. In this situation, the appropriate analysis is the cumulative incidence function (CIF). The use of competing risks analysis allows to build multistate models to describe the course of diseases. Appropriate multistate models in cirrhosis may allow to assess the risk of major events such as hepatocellular carcinoma, decompensation, refractory ascites, liver-related mortality, and other clinically relevant outcomes. A five-state model has been proposed to fit the clinical course of cirrhosis including two states in compensated and three states in decompensated cirrhosis.
Prognosis research by competing risks analysis may allow to identify prognostic indicators and to develop prognostic models. Specific statistical tools have been developed to assess discrimination and calibration of prognostic models developed by competing risks analysis, in validation studies.
Competing risks situations are frequent in the clinical course of cirrhosis and competing risks analysis should be appropriately used to achieve unbiased estimates.
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D’Amico, G. (2016). Competing Risks and Prognostic Stages in Cirrhosis. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_3
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DOI: https://doi.org/10.1007/978-3-319-23018-4_3
Publisher Name: Springer, Cham
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