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Fig. 3 | Annals of Intensive Care

Fig. 3

From: Urine NGAL as a biomarker for septic AKI: a critical appraisal of clinical utility—data from the observational FINNAKI study

Fig. 3

Decision curve analysis for a AKI, b severe (KDIGO 2–3), AKI, c RRT, and d 90-day mortality. Dashed black lines (baseline model) represent clinical risk models and dashed red lines represent new models with uNGAL. Black solid line: assume no patient has the outcome. Gray solid line: assume all patients have the outcome. a As the new model curve runs higher than the baseline curve, DCA shows a net benefit (NB) in identifying patients who will develop AKI at threshold probabilities of ≈ 0.25–0.35. The magnitude of the NB is 2.5% (95% CI 0.2–4.6%) at the predefined threshold probability of 0.30. However, at a threshold probability of 0.4, there is no NB at all. Note that if the models do not diverge from the gray line of “all expected positive”, neither of them adds anything to the strategy of expecting all to be positive at that threshold probability and should not be used. b With severe AKI, there is a 1.4% (95% CI 0.4–4.1%) NB at a threshold probability of 0.2. As with AKI, the NB does not persist within the area of clinically relevant threshold probabilities. c Adding uNGAL to the clinical RRT risk model gives a NB of 1.4% (95% CI 0.1–2.8%) in identifying patients who will end up in RRT at a threshold probability of 0.10. Note that at a threshold probability of ≈ 0.35 the curves intersect. d Decision curves for the clinical 90-day mortality risk model and for the clinical model including uNGAL do not diverge at a risk threshold of 0.05 thus showing no NB for adding uNGAL to the clinical risk model

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