Predicting fluid responsiveness in whom? A simulated example of patient spectrum influencing the receiver operating characteristics curve
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The influence of patient spectrum on the sensitivities and specificities of diagnostic methods has been termed spectrum bias or spectrum effect. Receiver operating characteristics curves are often used to assess the ability of diagnostic methods to predict fluid responsiveness. As a receiver operating characteristics curve is a presentation of sensitivity and specificity, the purpose of the present manuscript was to explore if patient spectrum could affect areas under receiver operating characteristics curves and their gray zones. Relationships between stroke volume variation and change in stroke volume in two different patient populations using simulated data. Simulated patient populations with stroke volume variation values between 5 and 15 or 3 and 25% had median (2.5th–97.5th percentiles) areas under receiver operating characteristics curves of 0.79 (0.65–0.90) and 0.93 (0.85–0.99), respectively. The gray zones indicating range of diagnostic uncertainty were also affected. The patient spectrum can affect common statistics from receiver operating characteristics curves, indicating the need for considering patient spectrum when evaluating the abilities of different methods to predict fluid responsiveness.
KeywordsDiagnostic techniques and procedures Sensitivity and specificity Population characteristics
This study was funded by departmental resources only.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 8.Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF, Group S (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 351:h5527. doi: 10.1136/bmj.h5527.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, Tavernier B. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115(2):231–241. doi: 10.1097/ALN.0b013e318225b80a.CrossRefPubMedGoogle Scholar
- 12.Kirkeby-Garstad I, Tronnes H, Stenseth R, Sellevold OF, Aadahl P, Skogvoll E. The precision of pulmonary artery catheter bolus thermodilution cardiac output measurements varies with the clinical situation. J Cardiothorac Vasc Anesth. 2015;29(4):881–888. doi: 10.1053/j.jvca.2014.12.016.CrossRefPubMedGoogle Scholar
- 13.Vos JJ, Poterman M, Salm PP, Van Amsterdam K, Struys MM, Scheeren TW, Kalmar AF. Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds: a prospective observational study. Can J Anaesth. 2015;62(11):1153–1160. doi: 10.1007/s12630-015-0464-2.CrossRefPubMedPubMedCentralGoogle Scholar