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Cited by 2,112

The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.

Use and Misuse of the Receiver Operating Characteristic Curve in Risk Prediction

Open access
Cook, Nancy R.·2007·Circulation
DOI 10.1161/circulationaha.106.672402
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Abstract

The c statistic, or area under the receiver operating characteristic (ROC) curve, achieved popularity in diagnostic testing, in which the test characteristics of sensitivity and specificity are relevant to discriminating diseased versus nondiseased patients. The c statistic, however, may not be optimal in assessing models that predict future risk or stratify individuals into risk categories. In this setting, calibration is as important to the accurate assessment of risk. For example, a biomarker with an odds ratio of 3 may have little effect on the c statistic, yet an increased level could shift estimated 10-year cardiovascular risk for an individual patient from 8% to 24%, which would lead to different treatment recommendations under current Adult Treatment Panel III guidelines. Accepted risk factors such as lipids, hypertension, and smoking have only marginal impact on the c statistic individually yet lead to more accurate reclassification of large proportions of patients into higher-risk or lower-risk categories. Perfectly calibrated models for complex disease can, in fact, only achieve values for the c statistic well below the theoretical maximum of 1. Use of the c statistic for model selection could thus naively eliminate established risk factors from cardiovascular risk prediction scores. As novel risk factors are discovered, sole reliance on the c statistic to evaluate their utility as risk predictors thus seems ill-advised.

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Metadata

Authors
Cook, N. R.
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-02-20
Volume
115
Issue
7
Pages
928-935
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.106.672402
OpenAlex
W2157995113
Cited by
2,112
References
6
FWCI
109.62
Type
journal article
Language
en
Open access
bronze

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