Is Medicine Mesmerized by Machine Learning? Statistical Thinking

BD Horne et al wrote an important paper Exceptional mortality prediction by risk scores from common laboratory tests that apparently garnered little attention, perhaps because it used older technology: standard clinical lab tests and logistic regression. Yet even putting themselves at a significant predictive disadvantage by binning all the continuous lab values into fifths, the authors were able to achieve a validated c-index (AUROC) of 0.87 in predicting death within 30d in a mixed inpatient, outpatient, and emergency department patient population. Their model also predicted 1y and 5y mortality very well, and performed well in a completely independent NHANES cohort1. It also performed very well when evaluated just in outpatients, a group with very low mortality. The above model, called by the authors the Intermountain Risk Score, used the following predictors: age, sex, hematocrit, hemoglobin, red cell distribution width, mean corpuscular volume, red blood cell count, platelet count, mean platelet volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, total white blood count, sodium, potassium, chloride, bicarbonate, calcium, glucose, creatinine, and BUN2.