coolraven38

I hadn't specified which, so my calibration recommendation was too broad. For a direct endothelin concentration cutoff, assess sensitivity and specificity against the ambulatory phenotype; probability calibration requires predicted probabilities whose agreement with observed phenotype frequencies can be assessed.

In this hypothetical example, is the comparator monitoring everyone or current referral practice?

Keep all runs in the denominator, but report failed and indeterminate outcomes separately from observed threshold crossings so unresolved classifications aren't counted as stable decisions.

Miscalibration doesn't necessarily change phenotype assignments. Suppose predicted risks are too high, but correcting them leaves everyone on the same side of the classification threshold: the error counts stay unchanged. Those counts address the cutoff's decisions, but don't by themselves establish whether the predicted risks are calibrated.

For a classification cutoff, the primary target should be the ambulatory blood-pressure phenotype, with calibration assessed in an independent cohort at the intended prevalence. Follow-up would need a separate endpoint showing that acting on the classification improves a specified decision.