ArticleEuropean journal of clinical investigation2012
Assessing the incremental value of diagnostic and prognostic markers: a review and illustration.
Article in European journal of clinical investigation, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 5 of them syntheses that pooled it.
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Who cites it
89 citing papers in PubMed, 5 syntheses or guidelines pooled it.
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- Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults Presenting to Emergency Departments with Mild Brain Injury: A Living Systematic Review and Meta-Analysis.Journal of neurotrauma · 2021Pooled it
- Prediction models for cardiovascular disease risk in the general population: systematic review.BMJ (Clinical research ed.) · 2016Pooled it
- Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. The TRIPOD Group.Circulation · 2015Guideline
- Inflammatory and metabolic biomarkers and risk of liver and biliary tract cancer.Hepatology (Baltimore, Md.) · 2014Trial
- Validation and simplification of the MR PREDICTS @24H model for outcome prediction after endovascular thrombectomy for acute ischemic stroke.International journal of stroke : official journal of the International Stroke Society · 2026Observational
- Serum Soluble Programmed Death Ligand-1 (sPD-L1) as a Diagnostic Marker in Neonatal Sepsis: Correspondence-2.Indian journal of pediatrics · 2026Article
- Incorporating Lower Urinary Tract Symptoms to Predict the Risk of Positive Prostate Magnetic Resonance Imaging.European urology open science · 2026Article
- Early Prediction Model for Retinopathy of Prematurity Using Placental and Neonatal Risk Factors.Investigative ophthalmology & visual science · 2026Article
- A five-year risk prediction model of cardiovascular disease in individuals with bipolar disorder: a nationwide register study from Sweden.Molecular psychiatry · 2026Article
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- A Quantitative Lung Mucin Score to Identify Chronic Bronchitis.NEJM evidence · 2026Article
- Serum biomarker trajectory clusters predict functional outcome and quality of life for traumatic brain injury.Brain communications · 2026Article
- Endometrial immune dysregulation shapes CD8Frontiers in immunology · 2026Article
- Predictive validity of chronic obstructive pulmonary disease phenotypes in inpatient elective surgery: a population-based study.British journal of anaesthesia · 2025Article
- Validation of a Dynamic Risk Prediction Model Incorporating Prior Mammograms in a Diverse Population.JAMA network open · 2025Article
- The Relevance of Optical Coherence Tomography Angiography in Screening and Monitoring Hypertensive Patients with Carotid Artery Stenosis.Diagnostics (Basel, Switzerland) · 2025Article
- Biomarker Panels for Predicting Progression of Kidney Disease in Acute Kidney Injury Survivors.Clinical journal of the American Society of Nephrology : CJASN · 2025Article
- Development of machine learning predictive model for type 2 diabetic retinopathy using the triglyceride-glucose index explained by SHAP method.Frontiers in endocrinology · 2025Article
29 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
Abstract
backgroundNew markers may improve prediction of diagnostic and prognostic outcomes. We review various measures to quantify the incremental value of markers over standard, readily available characteristics.
methodsWidely used traditional measures include the improvement in model fit or in the area under the receiver operating characteristic (ROC) curve (AUC). New measures include the net reclassification index (NRI) and decision-analytic measures, such as the fraction of true-positive classifications penalized for false-positive classifications [net benefit (NB)]. For illustration, we discuss a case study on the presence of residual tumour vs. benign tissue in 544 patients with testicular cancer. We assessed three tumour markers [Alpha-fetoprotein (AFP), Human chorionic gonadotropin (HCG) and Lactate dehydrogenase (LDH)] for their incremental value over currently standard clinical predictors.
resultsAUC and R(2) values suggested adding continuous LDH and AFP whereas NB only favoured HCG as a potentially promising marker at a clinically defendable decision threshold of 20% risk. The NRI suggested reclassification potential of all three markers.
conclusionsThe improvement in standard discrimination measures, which focus on finding variables that might be promising across all decision thresholds, may not detect the most informative markers at a specific threshold of particular clinical relevance. When a marker is intended to support decision-making, calculation of the improvement in a decision-analytic measure, such as NB, is preferable over an overall judgment as obtained from the AUC in ROC analysis.
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