Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers

Vickers, Andrew J.; Cronin, Angel M.; Elkin, Elena B.; Gönen, Mithat

doi:10.1186/1472-6947-8-53

Cited by 1,017 publications

(848 citation statements)

References 17 publications

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“…The decision curve analysis of the nomograms is shown in Figure 7. The decision curve showed that if the threshold probability of a patient or doctor was >10%, using the two nomograms to predict 1‐, 3‐, 5‐year DFS and OS added more benefit than either the treat‐all‐patients scheme or the treat‐none scheme 38. Within this range, the net benefit was comparable to several overlaps on the basis of the nomograms 41…”

Section: Resultsmentioning

confidence: 98%

“…The thin black line represents the assumption that no patients have 1‐, 3‐, or 5‐year survival. The net benefit was calculated by subtracting the proportion of all patients who are false‐positive from the proportion who are true‐positive, weighted by the relative harm of forgoing treatment compared with the negative consequences of an unnecessary treatment 38, 39. (A, C): DFS nomogram.…”

Section: Resultsmentioning

confidence: 99%

“…Decision curve analysis was conducted to assess the clinical usefulness of the model by quantifying the net benefits at different threshold probabilities 38, 39…”

Section: Methodsmentioning

confidence: 99%

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Prognostic significance of nomograms integrating IL‐37 expression, neutrophil level, and MMR status in patients with colorectal cancer

et al. 2018

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Interleukin (IL)‐37 and neutrophils are considered to be involved in human cancer, but their prognostic significance in colorectal cancer (CRC) has not been elucidated. The aim of this study was to evaluate the prognostic value of IL‐37 expression and neutrophil levels in CRC. We retrospectively analyzed IL‐37 expression, CD66b+ neutrophil levels, and mismatch repair (MMR) status in 337 paraffin‐embedded CRC specimens from the training cohort by immunohistochemistry. Their prognostic values were assessed using Kaplan‐Meier curves and multivariate Cox regression models. Moreover, several risk factors were used to form nomograms to evaluate survival, and the performance of the nomograms was assessed with respect to calibration, discrimination, and clinical usefulness. Further validation was performed in an independent cohort of 245 cases. Low IL‐37 expression and high CD66b+ neutrophil levels were significantly associated with diminished disease‐free survival (DFS) and overall survival (OS), and patients with MMR‐deficient CRC had better clinical outcomes. Furthermore, multivariate Cox analysis identified IL‐37, CD66b+ neutrophils, and MMR status as independent prognostic factors for DFS and OS. Two nomograms integrating the three markers with four clinicopathological risk factors were developed and validated for predicting DFS and OS with good calibration and discrimination (C‐index: training cohort, 0.798 (95% confidence interval:0.764‐0.832) and 0.828 (0.796‐0.860), respectively; validation cohort, 0.739 (0.696‐0.783) and 0.761 (0.715‐0.808), respectively). Decision curve analysis demonstrated that the nomograms were clinically useful. Intratumoral IL‐37, CD66b+ neutrophils, and MMR status were independent prognostic factors for CRC patients. Nomograms incorporating these biomarkers and clinicopathological features could be conveniently used to facilitate the individualized prediction of DFS and OS.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Prognostic significance of nomograms integrating IL‐37 expression, neutrophil level, and MMR status in patients with colorectal cancer

et al. 2018

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“…Integrated discrimination improvement and net reclassification improvement have been calculated using scores as continuous variables and according to a time‐dependent approach, whereas the clinical usefulness and net benefit were estimated using the decision curve analysis, according to the method proposed by Vickers et al 20, 21. In addition, we performed a sensitivity analysis comparing the 2 scores’ predictive performance, using an on‐treatment analysis.…”

Section: Methodsmentioning

confidence: 99%

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

Proietti

Rivera‐Caravaca

Esteve-Pastor

et al. 2018

JAHA

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BackgroundPatients with atrial fibrillation (AF) treated with oral anticoagulants may be exposed to an increased risk of bleeding events. The HAS‐BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs or alcohol) score is a simple, well‐established, clinical bleeding‐risk prediction score. Recently, a new algorithm‐based score was proposed, the GARFIELD‐AF (Global Anticoagulant in the Field–AF) bleeding score. We compared HAS‐BLED and GARFIELD‐AF scores in predicting adjudicated bleeding events in a clinical trial cohort of patients with AF taking anticoagulants, in the first external comparative validation of both scores.Methods and ResultsWe analyzed patients from the SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Patients With AF) III and V trials. All patients assigned to the warfarin arm with information to calculate the scores were considered. Outcomes were major, major/clinically relevant nonmajor, and any bleeding. A total of 3550 warfarin‐treated patients were available for analysis. Of these patients, 2519 (71.0%) had a HAS‐BLED score ≥3, whereas based on GARFIELD‐AF median value, 2056 (57.9%) were categorized as “high score.” Both HAS‐BLED and GARFIELD‐AF C‐indexes showed modest predictive value (C‐index [95% confidence interval] for major bleeding, 0.58 [0.56–0.60] and 0.56 [0.54–0.57], respectively); however, GARFIELD‐AF was not predictive of any bleeding. The GARFIELD‐AF bleeding score had a significantly lower sensitivity and a negative reclassification for any bleeding compared with HAS‐BLED, assessed by integrated discrimination improvement and net reclassification improvement (both P<0.001). HAS‐BLED showed a 5% net benefit for any bleeding occurrence.ConclusionsThe algorithm‐based GARFIELD‐AF bleeding score did not show any significant improvement in major and major/clinically relevant nonmajor prediction compared with the simple HAS‐BLED score. For clinical usefulness in prediction of any bleeding, the HAS‐BLED score showed a significant net benefit compared with the GARFIELD‐AF.

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“…Discrimination was assessed by Harrell's C index18 and by comparing Kaplan–Meier curves and hazard ratios between the predefined risk categories 7, 19. Clinical usefulness and net benefit were estimated with decision curve analysis 20. Calibration was assessed by comparing observed 1‐year event rates with predictions from the final model.…”

Section: Methodsmentioning

confidence: 99%

Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time

Hijazi

Lindahl

Oldgren

et al. 2017

JAHA

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BackgroundCardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker–based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short‐term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short‐term risk estimate.Methods and ResultsAccording to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1.8 years in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Cardiac troponin I, cardiac troponin T, and N‐terminal pro‐B‐type natriuretic peptide were measured with high‐sensitivity immunoassays. Associations with outcomes were evaluated by Cox regression. C indices and calibration plots were used to evaluate the ABC stroke score at 2 months. The average changes in biomarker levels during 2 months were small (median change cardiac troponin T +2.8%, troponin I +2.0%, and N‐terminal pro‐B‐type natriuretic peptide +13.5%) and within‐subject correlation was high (all ≥0.82). Repeated measurement of cardiac biomarkers provided some incremental prognostic value for mortality but not for stroke when combined with clinical risk factors and baseline levels of the biomarkers. Based on 8702 person‐years of follow‐up and 96 stroke/systemic embolic events, the ABC stroke score at 2 months achieved a similar C index of 0.70 (95% CI, 0.65–0.76) as compared with 0.70 (95% CI, 0.65–0.75) at baseline. The ABC stroke score remained well calibrated using predefined risk classes.ConclusionsIn patients with stable atrial fibrillation, the variability of the cardiac biomarkers and the biomarker‐based ABC stroke score during 2 months are small. The prognostic information by the ABC stroke score remains consistent and well calibrated with similar good predictive performance if patients are retested after 2 months.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.

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Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers

Cited by 1,017 publications

References 17 publications

Prognostic significance of nomograms integrating IL‐37 expression, neutrophil level, and MMR status in patients with colorectal cancer

Prognostic significance of nomograms integrating IL‐37 expression, neutrophil level, and MMR status in patients with colorectal cancer

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time

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