Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study

Jing Ning, Mohammad H. Rahbar, Sangbum Choi, Jin Piao, Chuan Hong, Deborah J. Del Junco, Elaheh Rahbar, Erin E. Fox, John B. Holcomb, Mei Cheng Wang

Research output: Contribution to journalArticle

Abstract

In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient's condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.

Original languageEnglish (US)
Pages (from-to)1969-1981
Number of pages13
JournalStatistical Methods in Medical Research
Volume26
Issue number4
DOIs
StatePublished - Aug 1 2017

Fingerprint

Recurrent Events
Informative Censoring
Blood Transfusion
Blood
Red Blood Cells
Platelets
Blood Platelets
Erythrocytes
Latent Variables
Wounds and Injuries
Critical Care
Plasma
Dependence Structure
Hemorrhage
Period of time
Asymptotic Properties
Timing
Time-varying
Evaluate
Model

Keywords

  • Informative censoring
  • multivariate recurrent event
  • rate ratio
  • transfusion medicine

ASJC Scopus subject areas

  • Epidemiology
  • Statistics and Probability
  • Health Information Management

Cite this

Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study. / Ning, Jing; Rahbar, Mohammad H.; Choi, Sangbum; Piao, Jin; Hong, Chuan; Del Junco, Deborah J.; Rahbar, Elaheh; Fox, Erin E.; Holcomb, John B.; Wang, Mei Cheng.

In: Statistical Methods in Medical Research, Vol. 26, No. 4, 01.08.2017, p. 1969-1981.

Research output: Contribution to journalArticle

Ning, J, Rahbar, MH, Choi, S, Piao, J, Hong, C, Del Junco, DJ, Rahbar, E, Fox, EE, Holcomb, JB & Wang, MC 2017, 'Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study', Statistical Methods in Medical Research, vol. 26, no. 4, pp. 1969-1981. https://doi.org/10.1177/0962280215593974
Ning, Jing ; Rahbar, Mohammad H. ; Choi, Sangbum ; Piao, Jin ; Hong, Chuan ; Del Junco, Deborah J. ; Rahbar, Elaheh ; Fox, Erin E. ; Holcomb, John B. ; Wang, Mei Cheng. / Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study. In: Statistical Methods in Medical Research. 2017 ; Vol. 26, No. 4. pp. 1969-1981.
@article{2c6e2f0637ee42d9a3f4cf528a5c9d72,
title = "Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study",
abstract = "In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient's condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.",
keywords = "Informative censoring, multivariate recurrent event, rate ratio, transfusion medicine",
author = "Jing Ning and Rahbar, {Mohammad H.} and Sangbum Choi and Jin Piao and Chuan Hong and {Del Junco}, {Deborah J.} and Elaheh Rahbar and Fox, {Erin E.} and Holcomb, {John B.} and Wang, {Mei Cheng}",
year = "2017",
month = "8",
day = "1",
doi = "10.1177/0962280215593974",
language = "English (US)",
volume = "26",
pages = "1969--1981",
journal = "Statistical Methods in Medical Research",
issn = "0962-2802",
publisher = "SAGE Publications Ltd",
number = "4",

}

TY - JOUR

T1 - Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study

AU - Ning, Jing

AU - Rahbar, Mohammad H.

AU - Choi, Sangbum

AU - Piao, Jin

AU - Hong, Chuan

AU - Del Junco, Deborah J.

AU - Rahbar, Elaheh

AU - Fox, Erin E.

AU - Holcomb, John B.

AU - Wang, Mei Cheng

PY - 2017/8/1

Y1 - 2017/8/1

N2 - In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient's condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.

AB - In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient's condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.

KW - Informative censoring

KW - multivariate recurrent event

KW - rate ratio

KW - transfusion medicine

UR - http://www.scopus.com/inward/record.url?scp=85027676705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027676705&partnerID=8YFLogxK

U2 - 10.1177/0962280215593974

DO - 10.1177/0962280215593974

M3 - Article

C2 - 26160825

AN - SCOPUS:85027676705

VL - 26

SP - 1969

EP - 1981

JO - Statistical Methods in Medical Research

JF - Statistical Methods in Medical Research

SN - 0962-2802

IS - 4

ER -