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Bartlett WA, Sandberg S, Carobene A, Fernandez-Calle P, Diaz-Garzon J, Coskun A, Jonker N, Galior K, Gonzales-Lao E, Moreno-Parro I, Sufrate-Vergara B, Webster C, Itkonen O, Marques-García F, Aarsand AK. A standard to report biological variation data studies - based on an expert opinion. Clin Chem Lab Med 2024; 0:cclm-2024-0489. [PMID: 38965828 DOI: 10.1515/cclm-2024-0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
There is a need for standards for generation and reporting of Biological Variation (BV) reference data. The absence of standards affects the quality and transportability of BV data, compromising important clinical applications. To address this issue, international expert groups under the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) have developed an online resource (https://tinyurl.com/bvmindmap) in the form of an interactive mind map that serves as a guideline for researchers planning, performing and reporting BV studies. The mind map addresses study design, data analysis, and reporting criteria, providing embedded links to relevant references and resources. It also incorporates a checklist approach, identifying a Minimum Data Set (MDS) to enable the transportability of BV data and incorporates the Biological Variation Data Critical Appraisal Checklist (BIVAC) to assess study quality. The mind map is open to access and is disseminated through the EFLM BV Database website, promoting accessibility and compliance to a reporting standard, thereby providing a tool to be used to ensure data quality, consistency, and comparability of BV data. Thus, comparable to the STARD initiative for diagnostic accuracy studies, the mind map introduces a Standard for Reporting Biological Variation Data Studies (STARBIV), which can enhance the reporting quality of BV studies, foster user confidence, provide better decision support, and be used as a tool for critical appraisal. Ongoing refinement is expected to adapt to emerging methodologies, ensuring a positive trajectory toward improving the validity and applicability of BV data in clinical practice.
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Affiliation(s)
- William A Bartlett
- Biomedical Engineering, School of Engineering and Science, University of Dundee, Dundee, Scotland
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- The Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Public Health and Primary Health Care University of Bergen, Bergen, Norway
| | - Anna Carobene
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Jorge Diaz-Garzon
- Laboratory Medicine Department, La Paz University Hospital, Madrid, Spain
| | - Abdurrahman Coskun
- School of Medicine, Department of Medical Biochemistry, Atasehir, Istanbul, Türkiye
- Acibadem Mehmet Ali Aydınlar University, Istanbul, Türkiye
| | - Niels Jonker
- Carte, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands
| | - Kornelia Galior
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Elisabet Gonzales-Lao
- Quality and Patient Safety Department, Consorci Sanitari de Terrassa, University Hospital, Barcelona, Spain
| | | | | | - Craig Webster
- Department of Biochemistry, Immunology and Toxicology, University Hospitals Birmingham, Birmingham, UK
| | - Outi Itkonen
- Endocrinology and Metabolism Laboratory, Helsinki University Hospital, Helsinki, Finland
| | - Fernando Marques-García
- Biochemistry Department, Metropolitan North Clinical Laboratory (LCMN), Germans Trias I Pujol University Hospital, Barcelona, Spain
| | - Aasne K Aarsand
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- The Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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Sandberg S, Carobene A, Bartlett B, Coskun A, Fernandez-Calle P, Jonker N, Díaz-Garzón J, Aarsand AK. Biological variation: recent development and future challenges. Clin Chem Lab Med 2022; 61:741-750. [PMID: 36537071 DOI: 10.1515/cclm-2022-1255] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 02/18/2023]
Abstract
Abstract
Biological variation (BV) data have many applications in laboratory medicine. However, these depend on the availability of relevant and robust BV data fit for purpose. BV data can be obtained through different study designs, both by experimental studies and studies utilizing previously analysed routine results derived from laboratory databases. The different BV applications include using BV data for setting analytical performance specifications, to calculate reference change values, to define the index of individuality and to establish personalized reference intervals. In this review, major achievements in the area of BV from last decade will be presented and discussed. These range from new models and approaches to derive BV data, the delivery of high-quality BV data by the highly powered European Biological Variation Study (EuBIVAS), the Biological Variation Data Critical Appraisal Checklist (BIVAC) and other standards for deriving and reporting BV data, the EFLM Biological Variation Database and new applications of BV data including personalized reference intervals and measurement uncertainty.
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Affiliation(s)
- Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Medical Biochemistry and Pharmacology , Norwegian Porphyria Centre, Haukeland University Hospital , Bergen , Norway
- Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Anna Carobene
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Bill Bartlett
- School of Science and Engineering, University of Dundee , Dundee , Scotland
| | - Abdurrahman Coskun
- Acibadem Mehmet Ali Aydınlar University, School of Medicine , Istanbul , Türkiye
| | - Pilar Fernandez-Calle
- Hospital Universitario La Paz, Quality Analytical Commission of Spanish Society of Clinical Chemistry (SEQC) , Madrid , Spain
| | - Niels Jonker
- Certe, Wilhelmina Ziekenhuis Assen , Assen , The Netherlands
| | - Jorge Díaz-Garzón
- Hospital Universitario La Paz, Quality Analytical Commission of Spanish Society of Clinical Chemistry (SEQC) , Madrid , Spain
| | - Aasne K. Aarsand
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Medical Biochemistry and Pharmacology , Norwegian Porphyria Centre, Haukeland University Hospital , Bergen , Norway
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Sandberg S, Carobene A, Aarsand AK. Biological variation - eight years after the 1st Strategic Conference of EFLM. Clin Chem Lab Med 2022; 60:465-468. [PMID: 35138052 DOI: 10.1515/cclm-2022-0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anna Carobene
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Aasne K Aarsand
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre, Haukeland University Hospital, Bergen, Norway
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Özcürümez M, Arzideh F, Torge A, Figge A, Haeckel R, Streichert T. The influence of sampling time on indirect reference limits, decision limits, and the estimation of biological variation of random plasma glucose concentrations. J LAB MED 2021. [DOI: 10.1515/labmed-2020-0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Plasma glucose concentrations exhibit a pronounced daytime-dependent variation. The oscillations responsible for this are currently not considered in the determination of reference limits (RL) and decision limits.
Methods
We characterized the daily variation inherent in large-scale laboratory data from two different university hospitals (site 1 n=513,682, site 2 n=204,001). Continuous and distinct RL for daytime and night were estimated. Diurnal characteristics of glucose concentrations were further investigated by quantile regression analyses introducing age and cosinor-functions as predictors in the model.
Results
Diurnal variations expressed as amplitude/Midline Estimating Statistic of Rhythm (MESOR) ratio, averaged 7.7% (range 5.9–9.3%). The amplitude of glucose levels decreased with increasing concentrations. Between 06:00 and 10:00 h an average decrease of 4% has to be considered. Nocturnal glucose samples accounted for only 5% of the total amount but contributed to 19.5% of all findings over 11.1 mmol/L. Partitioning of RL between day and night is merely justified for the upper reference limit. The nocturnal upper RLs for both genders differed from those obtained during the day by 11.0 and 10.6% at site 1 and by 7.6 and 7.5% at site 2.
Conclusions
We conclude that indirect approaches to estimate upper RL of random plasma glucose concentrations require stratification concerning the time of sample collection.
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Affiliation(s)
- Mustafa Özcürümez
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum , Bochum , Germany
| | - Farhad Arzideh
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum , Bochum , Germany
| | - Antje Torge
- Institut für Klinische Chemie , Universitätsklinikum Schleswig-Holstein , Kiel , Germany
| | - Anja Figge
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum , Bochum , Germany
| | - Rainer Haeckel
- Bremer Zentrum für Laboratoriumsmedizin, Klinikum Bremen Mitte , Bremen , Germany
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Díaz-Garzón Marco J, Fernández-Calle P, Ricós C. Models to estimate biological variation components and interpretation of serial results: strengths and limitations. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200063. [PMID: 37361500 PMCID: PMC10270238 DOI: 10.1515/almed-2020-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/22/2020] [Indexed: 06/28/2023]
Abstract
Biological variation (BV) has multiple applications in a variety of fields of clinical laboratory. The use of BV in statistical modeling is twofold. On the one hand, some models are used for the generation of BV estimates (within- and between-subject variability). Other models are built based on BV in combination with other factors to establish ranges of normality that will help the clinician interpret serial results for the same subject. There are two types of statistical models for the calculation of BV estimates: A. Direct methods, prospective studies designed to calculate BV estimates; i. Classic model: developed by Harris and Fraser, revised by the Working Group on Biological Variation of the European Federation of Laboratory Medicine. ii. Mixed-effect models. iii. Bayesian model. B. Indirect methods, retrospective studies to derive BV estimates from large databases of results. Big data. Understanding the characteristics of these models is crucial as they determine their applicability in different settings and populations. Models for defining ranges that help in the interpretation of individual serial results include: A. Reference change value and B. Bayesian data network. In summary, this review provides an overview of the models used to define BV components and others for the follow-up of patients. These models should be exploited in the future to personalize and improve the information provided by the clinical laboratory and get the best of the resources available.
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Affiliation(s)
- Jorge Díaz-Garzón Marco
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
- Servicio Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
| | - Pilar Fernández-Calle
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
- Servicio Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
| | - Carmen Ricós
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
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