Veit Peter Grunert

Diagnosis of rheumatoid arthritis: multivariate analysis of biomarkers

Abstract Objective. To test if a combination of biomarkers can increase the classification power of autoantibodies to cyclic citrullinated peptides (anti-CCP) in the diagnosis of rheumatoid arthritis (RA) depending on the diagnostic situation. Methods. Biomarkers were subject to three inclusion/exclusion criteria (discrimination between RA patients and healthy blood donors, ability to identify anti-CCP-negative RA patients, specificity in a panel with major non-rheumatological diseases) before univariate ranking and multivariate analysis was carried out using a modelling panel (n=906). To enable the evaluation of the classification power in different diagnostic settings the disease controls (n=542) were weighted according to the admission rates in rheumatology clinics modelling a clinic panel or according to the relative prevalences of musculoskeletal disorders in the general population seen by general practitioners modelling a GP panel. Results. Out of 131 biomarkers considered originally, we evaluated 32 biomarkers in this study, of which only seven passed the three inclusion/exclusion criteria and were combined by multivariate analysis using four different mathematical models. In the modelled clinic panel, anti-CCP was the lead marker with a sensitivity of 75.8% and a specificity of 94.0%. Due to the lack in specificity of the markers other than anti-CCP in this diagnostic setting, any gain in sensitivity by any marker combination is off-set by a corresponding loss in specificity. In the modelled GP panel, the best marker combination of anti-CCP and interleukin (IL)-6 resulted in a sensitivity gain of 7.6% (85.9% vs. 78.3%) at a minor loss in specificity of 1.6% (90.3% vs. 91.9%) compared with anti-CCP as the best single marker. Conclusions. Depending on the composition of the sample panel, anti-CCP alone or anti-CCP in combination with IL-6 has the highest classification power for the diagnosis of established RA.

Classification of therapy resistance based on longitudinal biomarker profiles.

To classify patients either as resistant or non-resistant to HIV therapy based on longitudinal viral load profiles, we applied longitudinal quadratic discriminant analysis and examined various measures, mainly derived from the Brier Score, to assess the biomarker performance in terms of discrimination and calibration. The analysis of the application data revealed an increase in performance by using longer profiles instead of single biomarker measurements. Simulations showed that the selection of mixed models for the estimation of the group-specific discriminant rule parameters should be based on BIC, rather than on the best performance measure. An incorrect model selection can lead to spuriously better or worse performance as misclassification and classification certainty regards, especially with increasing length of the profiles and for more complex models with random slopes.