1
|
Yin J, Samawi H, Tian L. Joint inference about the AUC and Youden index for paired biomarkers. Stat Med 2022; 41:37-64. [PMID: 34964512 DOI: 10.1002/sim.9222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
It is common to compare biomarkers' diagnostic or prognostic performance using some summary ROC measures such as the area under the ROC curve (AUC) or the Youden index. We propose to compare two paired biomarkers using both the AUC and the Youden index since the two indices describe different aspects of the ROC curve. This comparison can be made by estimating the joint confidence region (an elliptical area) of the differences of the paired AUCs and the Youden indices. Furthermore, for deciding if one marker is better than the other in terms of both the A U C and the Youden index (J), we can test H 0 : A U C a ≤ A U C b or J a ≤ J b against H a : A U C a > A U C b and J a > J b using the paired differences. The construction of such a joint hypothesis is an example of the multivariate order-restricted hypotheses. For such a hypothesis, we propose and compare three testing procedures: (1) the intersection-union test ( I U T ); (2) the conditional test; and (3) the joint test. The performance of the proposed inference methods was evaluated and compared through simulations. The simulation results demonstrate that the proposed joint confidence region maintains the desired confidence level, and all three tests maintain the type I error under the null. Furthermore, among the three proposed testing methods, the conditional test is the preferred approach with markedly larger power consistently than the other two competing methods.
Collapse
Affiliation(s)
- Jingjing Yin
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, Georgia, USA
| | - Hani Samawi
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, Georgia, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
2
|
Feng Q, Li J, Ping X, Van Calster B. Hypervolume under ROC manifold for discrete biomarkers with ties. J STAT COMPUT SIM 2021. [DOI: 10.1080/00949655.2021.1954184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Qunqiang Feng
- Department of Statistics and Finance, School of Management, University of Science and Technology of China, Hefei, People's Republic of China
| | - Jialiang Li
- National University of Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Xingrun Ping
- Shanghai Jiaotong University, Shanghai, People's Republic of China
| | | |
Collapse
|
3
|
The role of pulse pressure in navigating the paradigm of chronic kidney disease progression in type 2 diabetes mellitus. J Nephrol 2021; 34:1429-1444. [PMID: 33492590 DOI: 10.1007/s40620-020-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Arterial stiffness is a risk factor for chronic kidney disease progression (CKD). Pulse pressure is a surrogate marker of arterial stiffness. It is unclear if pulse pressure predicts CKD progression in type 2 diabetes mellitus. METHODS This was prospective study involving 1494 patients with estimated glomerular filtration rate (eGFR) ≥ 15 ml/min/1.73 m2. Carotid-femoral pulse wave velocity was measured using applanation tonometry. Pulse pressure was calculated as difference between systolic and diastolic blood pressures. CKD progression was defined as worsening of eGFR categories (stage 1, ≥ 90 ml/min/1.73 m2; stage 2, 60-89 ml/min/1.73 m2; stage 3a, 45-59 ml/min/1.73 m2; stage 3b, 30-44 ml/min/1.73 m2; stage 4; 15-29 ml/min/1.73 m2; and stage 5, < 15 ml/min/1.73 m2) with ≥ 25% decrease in eGFR from baseline. RESULTS After follow-up of up to 6 years, CKD progression occurred in 33.5% of subjects. Subjects in 2nd, 3rd and 4th quartiles of peripheral pulse pressure experienced higher risk of CKD progression with unadjusted hazard ratios (HRs) 1.55 [95% confidence interval (CI) 1.13-2.11; p = 0.006], 2.58 (1.93-3.45; p < 0.001) and 3.41 (2.58-4.52; p < 0.001). In the fully adjusted model, the association for 2nd, 3rd and 4th quartiles remained with HRs 1.40 (1.02-1.93; p = 0.038), 1.87 (1.37-2.56; p < 0.001) and 1.75 (1.25-2.44; p = 0.001) respectively. Similarly, 2nd, 3rd and 4th quartiles of aortic pulse pressure were associated with higher hazards of CKD progression with HRs 1.73 (1.25-2.40; p = 0.001), 1.65 (1.18-2.29; p = 0.003) and 1.81 (1.26-2.60; p = 0.001). Increasing urinary albumin-to-creatinine ratio accounted for 44.0% of the association between peripheral pulse pressure and CKD progression. CONCLUSIONS Individuals with high pulse pressure were more susceptible to deterioration of renal function. Pulse pressure could potentially be incorporated in clinical practice as an inexpensive and readily available biomarker of renal decline in type 2 diabetes mellitus. Graphic abstract.
Collapse
|
4
|
Keefe JA, Hwang SJ, Huan T, Mendelson M, Yao C, Courchesne P, Saleh MA, Madhur MS, Levy D. Evidence for a Causal Role of the SH2B3-β 2M Axis in Blood Pressure Regulation. Hypertension 2019; 73:497-503. [PMID: 30624993 DOI: 10.1161/hypertensionaha.118.12094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Genetic variants at SH2B3 are associated with blood pressure and circulating β2M (β-2 microglobulin), a well-characterized kidney filtration biomarker. We hypothesize that circulating β2M is an independent risk predictor of hypertension and may causally contribute to its development. The study sample consisted of 7 065 Framingham Heart Study participants with measurements of plasma β2M. Generalized estimating equations were used to test the association of β2M with prevalent and new-onset hypertension. There were 2 145 (30%) cases of prevalent hypertension at baseline and 886 (21%) cases of incident hypertension during 6 years of follow-up. A 1-SD increase in baseline plasma β2M was associated with a greater risk of prevalent (odds ratio 1.14, 95% CI 1.05-1.24) and new-onset (odds ratio 1.18, 95% CI 1.07-1.32) hypertension. Individuals within the top β2M quartile had a greater risk than the bottom quartile for prevalent (odds ratio 1.29, 95% CI 1.05-1.57) and new-onset (odds ratio 1.59, 95% CI 1.20-2.11) hypertension. These associations remained essentially unchanged in analyses restricted to participants free of albuminuria and chronic kidney disease. Mendelian randomization demonstrated that lower SH2B3 expression is causal for increased circulating β2M levels, and in a hypertensive mouse model, knockout of Sh2b3 increased β 2 M gene expression. In a community-based study of healthy individuals, higher plasma β2M levels are associated with increased risk of prevalent and incident hypertension independent of chronic kidney disease status. Overlapping genetic signals for hypertension and β2M, in conjunction with mouse knockout experiments, suggest that the SH2B3-β2M axis plays a causal role in hypertension.
Collapse
Affiliation(s)
- Joshua A Keefe
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.)
| | - Shih-Jen Hwang
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.)
| | - Tianxiao Huan
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.)
| | - Michael Mendelson
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.).,Department of Cardiology, Boston Children's Hospital, MA (M.M.)
| | - Chen Yao
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.)
| | - Paul Courchesne
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.)
| | - Mohamed A Saleh
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (M.A.S., M.S.M.).,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Egypt (M.A.S.)
| | - Meena S Madhur
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (M.A.S., M.S.M.)
| | - Daniel Levy
- From the Framingham Heart Study, MA (J.A.K., S.-J.H., T.H., M.M., C.Y., P.C., D.L.).,The Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.A.K., S.-J.H., T.H., M.M., C.Y., D.L.)
| |
Collapse
|
5
|
Akkermans A, Peelen LM, van Waes JA, Rinkel GJ, van Klei WA. Cardiac events within one year after a subarachnoid haemorrhage: The predictive value of troponin elevation after aneurysm occlusion. Eur J Prev Cardiol 2019; 26:420-428. [PMID: 29771155 PMCID: PMC6388411 DOI: 10.1177/2047487318776098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/18/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who survive after an aneurysmal subarachnoid haemorrhage (ASAH) have an increased incidence of cardiovascular events compared with the general population. We assessed whether troponin elevation after aneurysm occlusion, as marker of myocardial injury, can predict long-term cardiac events. METHODS We analysed a prospectively collected cohort of 159 patients with ASAH and early aneurysm occlusion, in whom routine post-intervention troponin I (TnI) measurements were performed. With competing risk regression modelling we estimated the association between TnI elevation after aneurysm occlusion and major adverse cardiac events within one year. Secondary outcome measures were all-cause mortality and neurological condition within one year. The predictive value of post-intervention TnI was compared with the predictive value of pre-intervention characteristics using c-statistics and the integrated discrimination improvement index. RESULTS Subdistribution hazard ratios for TnI elevation and major adverse cardiac events at one year were 1.05 (95% confidence interval (CI) 1.03-1.07) per 10 ng/l increase in TnI and 7.91 (95% CI 1.46-43.0) for any TnI elevation. After adjustment for pre-intervention variables, the subdistribution hazard ratios were 1.47 (95% CI 0.81-2.67) per 10 ng/l and 9.00 (95% CI 1.62-50.1) for any elevation. The c-statistic was 0.71 for TnI elevation as a continuous measure and 0.69 for any TnI elevation. The integrated discrimination improvement index showed a minimum improvement in prediction of 0.08 (interquartile range 0.06 to 0.09) for TnI as a continuous measure and 0.003 (interquartile range -0.004 to 0.01) for any TnI elevation, when compared with pre-intervention characteristics. CONCLUSION TnI elevation after occlusion of a ruptured intracranial aneurysm predicts the occurrence of a major adverse cardiac event within one year after ASAH.
Collapse
Affiliation(s)
- Annemarie Akkermans
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Linda M Peelen
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Judith A van Waes
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Gabriël J Rinkel
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Wilton A van Klei
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| |
Collapse
|
6
|
Karaismailoglu E, Konar NM, Goksuluk D, Karaagaoglu AE. Factors effecting the model performance measures area under the ROC curve, net reclassification improvement and integrated discrimination improvement. COMMUN STAT-SIMUL C 2018. [DOI: 10.1080/03610918.2018.1458135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Eda Karaismailoglu
- Department of Biostatistics, Faculty of Medicine, Kastamonu University, Kuzeykent, Kastamonu, Turkey
| | - Naime Meric Konar
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Dincer Goksuluk
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Ahmet Ergun Karaagaoglu
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| |
Collapse
|
7
|
Demler OV, Paynter NP, Cook NR. Reclassification calibration test for censored survival data: performance and comparison to goodness-of-fit criteria. Diagn Progn Res 2018; 2:16. [PMID: 30984876 PMCID: PMC6456068 DOI: 10.1186/s41512-018-0034-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The risk reclassification table assesses clinical performance of a biomarker in terms of movements across relevant risk categories. The Reclassification-Calibration (RC) statistic has been developed for binary outcomes, but its performance for survival data with moderate to high censoring rates has not been evaluated. METHODS We develop an RC statistic for survival data with higher censoring rates using the Greenwood-Nam-D'Agostino approach (RC-GND). We examine its performance characteristics and compare its performance and utility to the Hosmer-Lemeshow goodness-of-fit test under various assumptions about the censoring rate and the shape of the baseline hazard. RESULTS The RC-GND test was robust to high (up to 50%) censoring rates and did not exceed the targeted 5% Type I error in a variety of simulated scenarios. It achieved 80% power to detect better calibration with respect to clinical categories when an important predictor with a hazard ratio of at least 1.7 to 2.2 was added to the model, while the Hosmer-Lemeshow goodness of fit (gof) test had power of 5% in this scenario. CONCLUSIONS The RC-GND test should be used to test the improvement in calibration with respect to clinically-relevant risk strata. When an important predictor is omitted, the Hosmer-Lemeshow goodness-of-fit test is usually not significant, while the RC-GND test is sensitive to such an omission.
Collapse
Affiliation(s)
- Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0861,
| | - Nina P Paynter
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0798,
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0796
| |
Collapse
|