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Mixed-effects logistic approach for association following linkage scan for complex disorders.

An association study to identify possible causal single nucleotide polymorphisms following linkage scanning is a popular approach for the genetic dissection of complex disorders. However, in association studies cases and controls are assumed to be independent, i.e., genetically unrelated. Choosing a single affected individual per family is statistically inefficient and leads to a loss of power. On the other hand, because of the relatedness of family members, using affected family members and unrelated normal controls directly leads to false-positive results in association studies. In this paper we propose a new approach using mixed-model logistic regression, in which associations are performed using family members and unrelated controls. Thus, the important genetic information can be obtained from family members while retaining high statistical power. To examine the properties of this new approach we developed an efficient algorithm, to simulate environmental risk factors and the genotypes at both the disease locus and a marker locus with and without linkage disequilibrium (LD) in families. Extensive simulation studies showed that our approach can effectively control the type-I error probability. Our approach is better than family-based designs such as TDT, because it allows the use of unrelated cases and controls and uses all of the affected members for whom DNA samples are possibly already available. Our approach also allows the inclusion of covariates such as age and smoking status. Power analysis showed that our method has higher statistical power than recent likelihood ratio-based methods when environmental factors contribute to disease susceptibility, which is true for most complex human disorders. Our method can be further extended to accommodate more complex pedigree structures.

Algorithms↗

Estimation of probability of malignancy using a logistic model combining color Doppler ultrasonography, serum CA125 level in women with a pelvic mass.

The goal of this study was to develop a scoring system using combination of Doppler characterization of pelvic/ovarian lesions and serum CA125 level. Our purpose was to maximize the preoperative discrimination between benign and malignant entities. In a prospective study, a total of 101 patients were evaluated preoperatively using a standard transvaginal ultrasound and color Doppler imaging with pulse spectral analysis and serum CA125 level within a week prior to surgery. The variables that were analyzed by the multivariate logistic regression method are as follows: tumor structure, ascites, presence of septum, the peak systolic velocity (PSV), the resistance index (RI), and serum CA125 level. Of the 101 patients qualified for the study, 48 patients were diagnosed with benign (47.5%) and 53 (52.5%) with malignant tumors. Each criterion used alone provides statistically significant discrimination between benign and malignant tumors. Four criteria could be combined in a malignancy score which is calculated using the product of the serum CA125 level (1 if CA125 > or =40 U/mL and 0 if CA125 <40 U/mL), the result of sonography for presence of septum in tumor (1 if there was septum > or =3 mm, 0 if there was no septum or <3 mm), result of Doppler flow imaging as RI (1 if RI < or =0.5 and 0 if RI >0.5) and the PSV (1 if PSV > or =40 cm/s and 0 if PSV <40 cm/s). This scoring system devised was statistically more effective discriminator between cancer and benign lesions than formal methods. Using malignancy score cutoff level of two, the sensitivity was 98% (CI 88.62-99.9.), the specificity was 85% (CI 71.62-93.45), the positive predictive value was 87.5%, and the negative predictive value was 97.6%. Area under curve of receiver operative characteristic curves was 0.987 (CI 0.971-1.004). These values were statistically more significant than those obtained from the independent use of RI, PSV, or serum CA125 level at their optimum decision values (P < 0.05). There is a need for a prospective evaluation of this score using a larger sample of patients.

Adolescent↗

Fitting a two-parameter logistic item response model to clarify the psychometric properties of the Drug Use Screening Inventory for adolescent alcohol and drug abusers.

The suitability of fitting a two-parameter logistic item response model to the Drug Use Screening Inventory (DUSI) was assessed. In a sample of 846 adolescents, each of the 10 domains was found to be unidimensional. Invariance of the item parameters across different groups was also observed. The reliability coefficient, based on item response theory, was found to be superior. The results of these analyses indicate that the DUSI has sound psychometric properties.

Adolescent↗

Variable selection for logistic regression using a prediction-focused information criterion.

In biostatistical practice, it is common to use information criteria as a guide for model selection. We propose new versions of the focused information criterion (FIC) for variable selection in logistic regression. The FIC gives, depending on the quantity to be estimated, possibly different sets of selected variables. The standard version of the FIC measures the mean squared error of the estimator of the quantity of interest in the selected model. In this article, we propose more general versions of the FIC, allowing other risk measures such as the one based on L(p) error. When prediction of an event is important, as is often the case in medical applications, we construct an FIC using the error rate as a natural risk measure. The advantages of using an information criterion which depends on both the quantity of interest and the selected risk measure are illustrated by means of a simulation study and application to a study on diabetic retinopathy.

Biometry↗

A goodness-of-fit test for multinomial logistic regression.

This article presents a score test to check the fit of a logistic regression model with two or more outcome categories. The null hypothesis that the model fits well is tested against the alternative that residuals of samples close to each other in covariate space tend to deviate from the model in the same direction. We propose a test statistic that is a sum of squared smoothed residuals, and show that it can be interpreted as a score test in a random effects model. By specifying the distance metric in covariate space, users can choose the alternative against which the test is directed, making it either an omnibus goodness-of-fit test or a test for lack of fit of specific model variables or outcome categories.

Biometry↗

Inter-laboratory comparison of the CD-1 neonatal mouse logistic dose-response model for Cryptosporidium parvum oocysts.

cryptosporidium parvum oocyst viability can be determined by vital dyes, in vitro excystation, and cell culture; however, neonatal mouse infectivity assays are the reference method. Unfortunately, there have been few efforts to standardize methods for infectivity assays thus casting a veil of uncertainty over the significance and comparability of results. In order to address this issue, two laboratories proficient in measuring oocyst infectivity conducted independent dose titration studies with neonatal CD-1 mice using standardized protocols and a well-characterized isolate of Cryptosporidium parvum. The resulting independent logistic dose-response models derived by regression analysis were compared with each other and with a published model. The comparisons showed these dose-response functions to be reproducible under standardized conditions. It is important to standardize mouse strain, age of mice at inoculation and necropsy, oocyst isolate, and age of oocysts. However, other factors, including methods used to detect infectivity and to count oocyst doses, appear less critical. Adopting a standardized assay for oocyst infectivity will provide both a basis for comparing data from various oocyst disinfection studies and a suitable platform for evaluating new or existing in vitro viability surrogates such as excystation, vital dyes or cell culture.

Animals↗

A logistic regression model for the decision to perform access surgery.

Access surgery may be recommended to about 80% of patients who present with advanced forms of periodontal disease. In this report, a multivariate logistic regression analysis which incorporated several clinical parameters for each tooth examined, i.e., tooth type, furcation involvement, bleeding on probing, attachment level, probing depth, mobility and BANA test score, was conducted using generalized estimating equations (GEE). This approach identified parameters that were significantly associated at p < 0.05 level with the need for access surgery or extraction for periodontal purposes. The estimated probabilities derived from the GEE model were plotted over the complete spectrum of operating conditions to obtain a receiver-operator characteristic (ROC) curve. At a probability cutpoint of 0.8, the decision threshold for surgery/extraction at the pretreatment examination would have a sensitivity of 76.1% and a specificity of 75.3%. We have taken this 0.8 cut point to look at specific clinical decisions made by our examiners after the patients had received scaling and root planing plus 2 weeks unsupervised usage of systemic antimicrobials. The clinicians' decision was taken as the primary reference standard. The model's estimated decision agreed with the clinicians' decision in 226 of the 284 teeth, for an accuracy of 80%. The specificity was 90% and the sensitivity was 43%.

Algorithms↗

Aquifer vulnerability assessment to heavy metals using ordinal logistic regression.

A methodology using ordinal logistic regression is proposed to predict the probability of occurrence of heavy metals in ground water. The predicted probabilities are defined with reference to the background concentration and the maximum contaminant level. The model is able to predict the occurrence due to different influencing variables such as the land use, soil hydrologic group (SHG), and surface elevation. The methodology was applied to the Sumas-Blaine Aquifer located in Washington State to predict the occurrence of five heavy metals. The influencing variables considered were (1) SHG; (2) land use; (3) elevation; (4) clay content; (5) hydraulic conductivity; and (6) well depth. The predicted probabilities were in agreement with the observed probabilities under existing conditions. The results showed that aquifer vulnerability to each heavy metal was related to different sets of influencing variables. However, all heavy metals had a strong influence from land use and SHG. The model results also provided good insight into the influence of various hydrogeochemical factors and land uses on the presence of each heavy metal. A simple economic analysis was proposed and demonstrated to evaluate the cost effects of changing the land use on heavy metal occurrence.

Forecasting↗

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements.

OBJECTIVES: Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. METHODS: We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. RESULTS: While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. CONCLUSIONS: This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Adult↗

Logistic representation of the sensitometric response of screen-film systems: empirical validation.

An empirical logistic model that linearizes the sensitometric response data of screen-film systems over the entire dynamic range of exposures is presented. This linearization is evident when the net optical densities are scaled as fractions of the net saturation density and plotted on commercial logit, probit, or double-log paper, except under conditions of reciprocity law failure. Weighted linear regression analysis shows that the intercept, but not the slope, depends on the screen-film system used. Previous work indicates that the slope is also independent of development time and photon energy. The model is verified through an analysis of tabulated sensitometric data published by the Center for Devices and Radiological Health.

Logistic Models↗

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model.

OBJECTIVE: To develop a predictive model to triage patients for discharge from intensive care units to reduce mortality after discharge. DESIGN: Logistic regression analyses and modelling of data from patients who were discharged from intensive care units. SETTING: Guy's hospital intensive care unit and 19 other UK intensive care units from 1989 to 1998. PARTICIPANTS: 5475 patients for the development of the model and 8449 for validation. MAIN OUTCOME MEASURES: Mortality after discharge and power of triage model. RESULTS: Mortality after discharge from intensive care was up to 12.4%. The triage model identified patients at risk from death on the ward with a sensitivity of 65.5% and specificity of 87.6%, and an area under the receiver operating curve of 0.86. Variables in the model were age, end stage disease, length of stay in unit, cardiothoracic surgery, and physiology. In the validation dataset the 34% of the patients identified as at risk had a discharge mortality of 25% compared with a 4% mortality among those not at risk. CONCLUSIONS: The discharge mortality of at risk patients may be reduced by 39% if they remain in intensive care units for another 48 hours. The discharge triage model to identify patients at risk from too early and inappropriate discharge from intensive care may help doctors to make the difficult clinical decision of whom to discharge to make room for a patient requiring urgent admission to the unit. If confirmed, this study has implications on the provision of resources.

APACHE↗

Prognosis of conservatively treated patients with Pott's paraplegia: logistic regression analysis.

OBJECTIVE: To evaluate the prognostic significance of various clinical, radiological, and neurophysiological findings in conservatively treated patients with Pott's paraplegia, using multiple regression analysis. METHODS: The study included 43 patients with Pott's paraplegia, managed conservatively. The diagnosis of Pott's spine was based on clinical, magnetic resonance imaging, and computed tomography or ultrasound guided aspiration biopsy. All patients were examined clinically, and motor evoked potentials (MEPs) to lower limbs and tibial somatosensory evoked potentials (SEP) were recorded. Outcome at six months was defined as good or poor. For evaluating predictors of outcome, 15 clinical, investigative, and evoked potential variables were analysed, using multiple logistic regression analysis. RESULTS: The age range of the patients was 16-70 years, and 22 were female. Mild spasticity with hyperreflexia only was seen in 13 patients. In the remaining, weakness was severe in eight, and moderate and mild in 11 patients each. Twenty patients had loss of joint position sensation. MEP and SEP were abnormal in 19 and 18 patients, respectively. On multiple regression analysis, the best model predicting six month outcome included power, paraplegia score, SEP, and MEP. CONCLUSION: Patients with Pott's paraplegia are likely to recover completely by six months if they have mild weakness, lower paraplegia score and normal SEPs and MEPs.

Adolescent↗

Prognosis for recovery from prolonged posttraumatic unawareness: logistic analysis.

This study reviews the course and outcome of 130 patients who remained in a state of prolonged unawareness 30 days after severe cranio-cerebral trauma. Prognostic indicators and outcome were fitted by a logistic model. The significant prognostic factors observable in the first week after trauma were found to be ventilatory status, motor reactivity and significant extraneural trauma. The significant prognostic factors after the first month of unawareness were early ventilatory status, early motor reactivity, late epilepsy and hydrocephalus. The estimated probability of recovery of awareness (that is, consciousness) ranged from 0.94 in patients with early decorticate posturing in the absence of both extraneural trauma and ventilatory disturbance to 0.06 in patients with flaccidity, extraneural trauma and ventilatory disturbance in the first week after injury.

Arousal↗

Multiple logistic regression analysis of risk factors for the development of steroid-dependent asthma in the elderly: a comparison with younger asthmatics.

BACKGROUND: The percentage of the aged among all patients with bronchial asthma is increasing. OBJECTIVE: To investigate the risk factors for the development of steroid-dependent asthma in the elderly. METHODS: A multiple logistic regression analysis involving various clinical factors between steroid-dependent and -independent asthma was carried out for 59 asthmatics aged over 60 years, including 16 patients with steroid-dependent asthma. The calculated risk for each factor was compared with that obtained from 122 younger asthmatics aged 20-59 years. RESULTS: Among the factors examined (sex, age, period from onset of asthma, type of asthma and family history of asthma, plus history of smoking, atopic dermatitis, allergic rhinitis, chronic sinusitis and nasal polyps), the significant risk factors for the development of steroid dependency in the elderly asthmatics were only family history of bronchial asthma (relative risk 3.6) and smoking history (relative risk 6.9). CONCLUSIONS: Some risk factors for steroid-dependent asthma in younger individuals were not significant in the elderly. Since the smoking history was most closely associated with the development of steroid dependency in the elderly, even though most of them had quit smoking, it is important for patients with asthma to avoid smoking.

Adult↗

Prediction of intra-twin birth weight discordance by binary logistic regression analysis.

AIMS: Identification of women at high risk of intra-twin birth weight discordance is helpful in obstetric care of these pregnancies. The aim of this study is to establish an intra-twin birth weight discordance prediction model. METHODS: We created an intra-twin birth weight discordance prediction model by logistic regression, based on the 1995-1997 register twin birth data of the USA. The twin sets were randomly divided into two groups: group 1 to establish the prediction model and group 2 to validate the prediction model. Intra-twin birth weight discordance was defined as birth weight discordance > 25%. The prediction model was validated by receiver operating characteristic curve. RESULTS: A birth weight discordance prediction model including maternal age (beta = 0.069), parity (beta = 0.250), fetal gender concordance (beta = 0.041), maternal hypertension (beta = 0.368), eclampsia (beta = 0.316), other medical complication (beta = 0.165), and smoking (beta = 0.164) was established, yielded a 0.558 area under the receiver operating characteristic curve. The sensitivity, specificity, and positive predictive values were 38.1, 69.7, and 10.8%, respectively, at the cut-off value of 0.09 in group 2. CONCLUSION: A birth weight discordance prediction model that includes seven variables available during pregnancy has been established with acceptable diagnostic performance.

Area Under Curve↗

Noninvasive predictors of mortality for patients with Chagas' heart disease: a multivariate stepwise logistic regression study.

This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas' heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas' disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 +/- 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 +/- 23 mm Hg, diastolic blood pressure 76 +/- 11 mm Hg and resting heart rate 77 +/- 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 +/- 4 mEq/l, K+ was 4.34 +/- 0.73 mEq/l and creatinine level 1.34 +/- 0.31 mg/100 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 +/- 0.16, left ventricular systolic dimension of 51.23 +/- 13.53 mm and left ventricular diastolic dimension of 62.94 +/- 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

Logistic regression analysis of low grade spindle cell lesions. A cytologic study.

OBJECTIVE: To identify key diagnostic cytologic criteria for various low grade spindle cell lesions. STUDY DESIGN: We reviewed 20 synovial sarcomas, 18 benign neural tumors, 10 reparative lesions, 24 other benign and 27 additional malignant low grade spindle cell lesions. All specimens were coded as to the presence or absence of the following variables: high cellularity, tissue fragments, tissue culture appearance, epithelial fragments, vessel fragments, vascular arcades, fibrillar ground substance, myxoid background, microcystic areas, parallel arrangement of nuclei, naked nuclei, single cells, binucleate cells, multinucleate cells, long filamentous cells, short spindle cells, stellate cells, lipoblasts, nuclear pleomorphism, nuclei with pointed ends, comma/fishhook nuclei, cigar-shaped nuclei, ovoid/round nuclei, small nucleoli, large nucleoli, mitotic figures, intranuclear vacuoles and background histiocytes. A logistic regression analysis was performed to identify the variables predictive of malignant lesions, specifically synovial sarcomas, benign neural tumors and reparative lesions. RESULTS: Statistical analysis selected high cellularity, short spindle cells, small nucleoli and absence of tissue culture appearance as the main criteria for malignant neoplasms. Tissue fragments and high cellularity were selected as the primary criteria and absence of long filamentous cells and of myxoid background as the secondary criteria for synovial sarcomas. It selected fibrillar ground substance and absence of ovoid/round nuclei as the key criteria for benign neural tumors. The presence of a tissue culture appearance was the major criterion for reparative lesions. CONCLUSION: There are many previously described cytologic criteria, but we found that when subjected to statistical analysis, only a few features were significant in the evaluation of low grade spindle cell lesions.

Biopsy↗

Logistic regression analysis of high grade spindle cell neoplasms. A fine needle aspiration cytologic study.

OBJECTIVE: To identify primary diagnostic cytologic criteria for various high grade spindle cell neoplasms. STUDY DESIGN: We reviewed 30 osteosarcomas, 29 malignant fibrous histiocytomas (MFH), 26 malignant melanomas, 13 chondrosarcomas, 12 leiomyosarcomas, 7 angiosarcomas and 5 liposarcomas. All specimens were coded as to the presence or absence of the following variables: high or low cellularity, tissuelike fragments, glandlike fragments, single cells, binucleated cells, multinucleated cells, lipoblastlike cells, histiocytelike cells, fibroblastlike cells, signet-ring cells, short spindle cells, long filamentous cells, stellate cells, osteoclastic giant cells, malignant giant cells, background cells, pointed nuclei, cigar-shaped nuclei, fishhook-shaped nuclei, round or ovoid nuclei, intranuclear vacuoles, macronucleoli, small nucleoli, mitotic figures, abnormal mitotic figures, pleomorphism, nuclear/cytoplasmic ratio (mild, moderate, marked increase), amount of cytoplasm (scant, moderate, abundant), fine or coarse granular cytoplasm, intracytoplasmic hemosiderin deposits, melanin, cytoplasmic vacuoles, fat, capillary vessel fragments, storiform pattern, necrosis, large or small amount of myxoid material, filamentous stroma, dense collagenous stroma, osteoid, chondroid and cells in lacunae. A logistic regression analysis was performed to identify the variables predictive of each diagnostic category. RESULTS: The statistical analysis selected positive expression of osteoid, osteoclastic giant cells and low cellularity as the primary criteria associated with osteosarcomas. Positive expression of fibroblastlike cells, large amount of myxoid material and multinucleated cells were identified to be the key criteria for MFH. The analysis selected the presence of melanin as the major criterion for malignant melanomas, cells lying in lacunae for chondrosarcomas, fishhook nuclei for leiomyosarcomas, intracytoplasmic iron deposits for angiosarcomas and lipoblastlike cells for liposarcomas. CONCLUSION: From the previously described cytologic criteria, statistical analysis helped identify several key features that are significant in the evaluation of pleomorphic spindle cell neoplasms.

Biopsy, Needle↗