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Mah J, Magari R, Lo KK, Winden N, Xu G. A benefit risk approach in cutoff determination for diagnostic tests. Clin Chim Acta 2024; 559:117887. [PMID: 38643818 DOI: 10.1016/j.cca.2024.117887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024]
Abstract
A crucial step in the design of a diagnostic test is determining the cutoff point, the threshold which separates a negative measurement from a positive one. The results of a diagnostic test have clinical consequences: only when disease is accurately detected, proper treatments be administered, and vice versa. Benefit-Risk (BR) analysis should be used to determine the optimal cutoff point that optimizes the consequence. Quantitative BR analysis requires measurable benefit and risk and a function, e.g., linear or ratio, to combine all the components. When BR corresponding to the four possible diagnostic test outcomes are all scaled in units of risk resulting from an untreated disease, we propose a net BR (linear BR) equation as a function of diagnostic parameters, disease prevalence, benefit of correct diagnosis and risk of false diagnostic results. Optimal cutoff of a diagnostic test can be obtained using this function. Comparison of diagnostic tests based on their benefit and risk of tests is also discussed. Use of this function is illustrated with a biosensor rapid antigen test for SARS-CoV-2.
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Affiliation(s)
- Jeng Mah
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Chaska, MN, USA.
| | - Robert Magari
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Miami, Florida, USA.
| | - Karen Kw Lo
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Miami, Florida, USA.
| | - Nicole Winden
- Department of Biostatistics and Data Management, Beckman Coulter, Inc. Chaska, MN, USA.
| | - Gang Xu
- Department of Biostatistics, Vertex Pharmaceuticals, Inc. Boston, MA, USA.
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Wang J, Yin J, Tian L. Evaluating joint confidence region of hypervolume under ROC manifold and generalized Youden index. Stat Med 2024; 43:869-889. [PMID: 38115806 DOI: 10.1002/sim.9998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/25/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
In biomarker evaluation/diagnostic studies, the hypervolume under the receiver operating characteristic manifold (HUM K $$ {\mathrm{HUM}}_K $$ ) and the generalized Youden index (J K $$ {J}_K $$ ) are the most popular measures for assessing classification accuracy under multiple classes. WhileHUM K $$ {\mathrm{HUM}}_K $$ is frequently used to evaluate the overall accuracy,J K $$ {J}_K $$ provides direct measure of accuracy at the optimal cut-points. Simultaneous evaluation ofHUM K $$ {\mathrm{HUM}}_K $$ andJ K $$ {J}_K $$ provides a comprehensive picture about the classification accuracy of the biomarker/diagnostic test under consideration. This article studies both parametric and non-parametric approaches for estimating the confidence region ofHUM K $$ {\mathrm{HUM}}_K $$ andJ K $$ {J}_K $$ for a single biomarker. The performances of the proposed methods are investigated by an extensive simulation study and are applied to a real data set from the Alzheimer's Disease Neuroimaging Initiative.
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Affiliation(s)
- Jia Wang
- Department of Biostatistics, University at Buffalo, Buffalo, New York, USA
| | - Jingjing Yin
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, Buffalo, New York, USA
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Lee HJ, Yoo SG, Lee SJ, Han JS, Choi IY, Park KH. Association between HbA1c and hearing loss: a tertiary care center-based study. Sci Rep 2023; 13:18409. [PMID: 37891326 PMCID: PMC10611790 DOI: 10.1038/s41598-023-44909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to investigate the correlation between glycated hemoglobin (HbA1c) levels and hearing loss (HL) using data from a tertiary hospital. Our hypothesis regarding the relationship between HL and HbA1c levels was that elevated HbA1c levels are associated with an increased risk of HL. We retrospectively reviewed the medical charts of patients diagnosed with sensorineural HL or diabetes between 2006 and 2021 at the Catholic Medical Center (CMC). Data were collected from the CMC's Clinical Data Warehouse. Participants were selected from patients who were prescribed pure-tone audiometry and an HbA1c blood test. The survey was completed for 5287 participants. The better ear pure-tone audiometry (PTA) for air conduction thresholds at 500, 1000, 2000, and 4000 Hz was calculated. Sensorineural HL was defined as a better ear PTA of 25 dB or higher. We used the HbA1c level as a diagnostic criterion for diabetes. The following criteria were used to define the HbA1c level: normal, HbA1c level below 5.6%; prediabetes, level between 5.6 and 6.4%; and diabetes, level of 6.5% or more. Among 5287 participants, 1129 were categorized as normal, 2119 as prediabetic, and 2039 as diabetic. The diabetic group was significantly older (p < 0.05). The PTA also significantly deteriorated in the diabetes group (p < 0.05). We analyzed the effects of age, sex, and HbA1c level on frequency-specific hearing using multiple regression. The hearing thresholds at all frequencies deteriorated significantly with increasing age and HbA1c level (p < 0.05). A case-control study was also performed to facilitate a comprehensive comparison between distinct groups. The participants were categorized into two groups: a case (PTA > 25 dB) and control group (PTA ≤ 25 dB), based on their PTA threshold of four frequencies. After adjusting for age and sex, we found no significant odds ratio (OR) of HL between the prediabetes group and the normal group. Notably, the OR of HL was significantly higher in the diabetes group with each PTA threshold and frequency. The 6.3% HbA1c level cutoff value was determined by analyzing the receiver operating characteristic curve for predicting hearing impairment > 25 dB. Diabetes was associated with hearing loss in all frequency ranges, particularly at high frequencies. Screening for HL is strongly recommended for patients with elevated HbA1c levels.
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Affiliation(s)
- Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Goo Yoo
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sun Jung Lee
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jae Sang Han
- Department of Otolaryngology-Head & Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Kyoung Ho Park
- Department of Otolaryngology-Head & Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Staufer K, Mangal B, Trauner M. Detection of unreported alcohol consumption in fatty liver disease. J Hepatol 2023; 78:e67-e69. [PMID: 36309132 DOI: 10.1016/j.jhep.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Katharina Staufer
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Austria; Department of General Surgery, Division of Transplantation, Medical University of Vienna, Austria.
| | | | - Michael Trauner
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Austria
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