Lee Wen-Chung, Wu Yun-Chun
From the Institute of Epidemiology and Preventive Medicine (W-CL, Y-CW), and Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan (W-CL).
Medicine (Baltimore). 2016 Jan;95(2):e2477. doi: 10.1097/MD.0000000000002477.
The area under the receiver operating characteristic curve is a widely used index to characterize the performance of diagnostic tests and prediction models. However, the index does not explicitly acknowledge the utilities of risk predictions. Moreover, for most clinical settings, what counts is whether a prediction model can guide therapeutic decisions in a way that improves patient outcomes, rather than to simply update probabilities.Based on decision theory, the authors propose an alternative index, the "average deviation about the probability threshold" (ADAPT).An ADAPT curve (a plot of ADAPT value against the probability threshold) neatly characterizes the decision-analysis performances of a risk prediction model.Several prediction models can be compared for their ADAPT values at a chosen probability threshold, for a range of plausible threshold values, or for the whole ADAPT curves. This should greatly facilitate the selection of diagnostic tests and prediction models.
受试者工作特征曲线下面积是一种广泛用于表征诊断测试和预测模型性能的指标。然而，该指标并未明确考虑风险预测的效用。此外，对于大多数临床情况而言，重要的是预测模型能否以改善患者预后的方式指导治疗决策，而不仅仅是更新概率。基于决策理论，作者提出了一种替代指标，即“概率阈值平均偏差”（ADAPT）。ADAPT曲线（ADAPT值与概率阈值的关系图）可以清晰地表征风险预测模型的决策分析性能。可以在选定的概率阈值、一系列合理的阈值范围内或整个ADAPT曲线上比较几个预测模型的ADAPT值。这将极大地促进诊断测试和预测模型的选择。
