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Prospective meta-analysis using individual patient data in intensive care medicine

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Abstract

Meta-analysis is a technique for combining evidence from multiple trials. However, meta-analyses of studies with substantial heterogeneity among patients within trials—common in intensive care—can lead to incorrect conclusions if performed using aggregate data. Use of individual patient data (IPD) can avoid this concern, increase the power of a meta-analysis, and is useful for exploring subgroup effects. Barriers exist to IPD meta-analysis, most of which are overcome if clinical trials are designed to prospectively facilitate the incorporation of their results with other trials. We review the features of prospective IPD meta-analysis and identify those of relevance to intensive care research. We identify three clinical questions, which are the subject of recent or planned randomised controlled trials where IPD MA offers advantages over approaches using aggregate data.

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Acknowledgments

We are grateful to Professor S. Finfer of the George Institute for International Health for his advice on the content of the manuscript. The ProCESS investigators are funded by a P50 award (GM076659) from the National Institute of General Medical Sciences of the United States. The ARISE investigators are funded by a grant (491075) from the Australian National Health and Medical Research Council.

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  1. Michael C. Reade

    Present address: Department of Intensive Care Medicine, Austin Hospital, University of Melbourne, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia

Authors and Affiliations

  1. CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Michael C. Reade, Donald M. Yealy & Derek C. Angus

  2. Australian and New Zealand Intensive Care Society Clinical Trials Group, Melbourne, Australia

    Michael C. Reade, Anthony Delaney & Rinaldo Bellomo

  3. Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

    Michael J. Bailey & Rinaldo Bellomo

  4. Intensive Care National Audit and Research Centre, London, UK

    David A. Harrison & Kathryn M. Rowan

  5. Australasian College for Emergency Medicine Clinical Trials Group, Melbourne, Australia

    Peter G. Jones

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  1. Michael C. Reade
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Correspondence to Michael C. Reade.

Additional information

For the Australian Resuscitation in Sepsis Evaluation (ARISE), United Kingdom Protocolised Management In Sepsis (ProMISe), and United States Protocolized Care for Early Septic Shock (ProCESS) Investigators. A full list of investigators is contained in Appendix 1.

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1655-5.

Appendix 1

Appendix 1

The ARISE investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group, the ANZIC Research Centre and the Australasian College for Emergency Medicine: R. Bellomo, P.A. Cameron, D.J. Cooper, S.L. Peake, S.A. Webb, A. Delaney, A. Holdgate, B. Howe, P.G. Jones, A. Jovanovska, J.A. Myburgh, D. Rajbhandari, G. Syres, A. Nichol, M.C. Reade.

The ProCESS investigators of the University of Pittsburgh and collaborating institutions: D.C. Angus, D.M. Yealy, M.P. Fink, D.T. Huang, S.R. Gunn, J.A. Kellum, R.L. Delude, L.A. Weissfeld, L. Kong, H.B. Nguyen, N. Shapiro, T.L. Young, D. Stapleton, D. DelGrosso, X. Tang, J.R. Gigler, J. Luther, J.R. Begue, J.J. Davis, F. LoVecchio, R. Carlson, S. Swadron, H. Belzberg, M. Strehlow, R.G. Pearl, E.A. Panacek, T. Albertson, J. Fine, M. Carius, D. Orban, T. Ellender, C. Naum, L. May, L.S. Chawla, P.C. Hou, A. Massaro, M. Filbin, A. Waxman, A. Sama, T. Slesinger, R. Sinert, S. Nabors, R. Moscati, S. Cloud, S. Glickman, J. Govert, T. R. Delbridge, M. Mazer, C.B. Cairns, A. Patel, Z. Shaman, J. Caterino, N. Ali, J. Ufberg, J.M. Travaline, T. Allen, C. Grissom, D. Fosnocht, E. J. Kimball, O. Lander.

The ProMISe investigators of the UK Intensive Care National Audit and Research Centre, the UK Intensive Care Society, the UK College of Emergency Medicine, and the Society for Acute Medicine: K.M. Rowan, D.A. Harrison, R.D. Grieve, D. Bell, J. Bion, T. Coats, T. Hodgetts, M. Singer, J.D. Young.

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Reade, M.C., Delaney, A., Bailey, M.J. et al. Prospective meta-analysis using individual patient data in intensive care medicine. Intensive Care Med 36, 11–21 (2010). https://doi.org/10.1007/s00134-009-1650-x

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