Bayesian nonparametric inference for the three-class Youden index and its associated optimal cut-points

The three-class Youden index serves both as a measure of medical test accuracy and a criterion to choose the optimal pair of cutoff values for classifying subjects into three ordinal disease categories (e.g., no disease, mild disease, advanced disease). We present a Bayesian nonparametric approach for estimating the three-class Youden index and its corresponding optimal cutoff values based on Dirichlet process mixtures, which are robust models that can handle intricate features of distributions for complex data. Results from a simulation study are presented and an application to data from the Trail Making Test to assess cognitive impairment in Parkinson’s disease patients is detailed.