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May 25, 2005

Risk Stratification for In-Hospital Mortality in Acutely Decompensated Heart Failure—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(20):2467-2468. doi:10.1001/jama.293.20.2468-a

In Reply: We agree with Drs Royston and Altman that the AUROC for the logistic regression model was greater than that for the CART model. We also recognize that there remains a debate regarding the relative merits of CART compared with other models. Both the dichotomization of continuous predictors and the classification of patients into a finite number of risk categories can contribute to a reduction in the AUROC. However, the AUROC may not be the best way of assessing the accuracy of nonlinear models such as CART and newer, more complex statistical methods to assess this accuracy are being explored.1 Our evaluation was limited to the AUROC comparison because these new methods are not fully developed or readily available.