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Item The Biological Variation Data Critical Appraisal Checklist: A Standard for Evaluating Studies on Biological Variation(AMER ASSOC CLINICAL CHEMISTRY, 2018-01-01) Aarsand, Aasne K.; Roraas, Thomas; Fernandez-Calle, Pilar; Ricos, Carmen; Diaz-Garzon, Jorge; Jonker, Niels; Perich, Carmen; Gonzalez-Lao, Elisabet; Carobene, Anna; Minchinela, Joana; Coskun, Abdurrahman; Simon, Margarita; Alvarez, Virtudes; Bartlett, William A.; Fernandez-Fernandez, Pilar; Boned, Beatriz; Braga, Federica; Corte, Zoraida; Aslan, Berna; Sandberg, Sverre; Chem, European Federation Clinical; Variation, Working Grp Biological; Biological, Task \& Finish GrpBACKGROUND: Concern has been raised about the quality of available biological variation (BV) estimates and the effect of their application in clinical practice. A European Federation of Clinical Chemistry and Laboratory Medicine Task and Finish Group has addressed this issue. The aim of this report is to (a) describe the Biological Variation Data Critical Appraisal Checklist (BIVAC), which verifies whether publications have included all essential elements that may impact the veracity of associated BV estimates, (b) use the BIVAC to critically appraise existing BV publications on enzymes, lipids, kidney, and diabetes-related measurands, and (c) apply metaanalysis to deliver a global within-subject BV (CVI) estimate for alanine aminotransferase (ALT). METHODS: In the BIVAC, publications were rated as A, B, C, or D, indicating descending compliance for 14 BIVAC quality items, focusing on study design, methodology, and statistical handling. A D grade indicated that associated BV estimates should not be applied in clinical practice. Systematic searches were applied to identify BV studies for 28 different measurands. RESULTS: In total, 128 publications were identified, providing 935 different BV estimates. Nine percent achieved D scores. Outlier analysis and variance homogeneity testing were scored as C in >60\% of 847 cases. Metaanalysis delivered a CVI estimate for ALT of 15.4\%. CONCLUSIONS: Application of BIVAC to BV publications identified deficiencies in required study detail and delivery, especially for statistical analysis. Those deficiencies impact the veracity of BV estimates. BV data from BIVAC-compliant studies can be combined to deliver robust global estimates for safe clinical application. (c) 2017 American Association for Clinical ChemistryItem Biological variation data for lipid cardiovascular risk assessment biomarkers. A systematic review applying the biological variation data critical appraisal checklist (BIVAC)(ELSEVIER, 2019-01-01) Diaz-Garzon, Jorge; Fernandez Calle, Pilar; Minchinela, Joana; Aarsand, Aasne K.; Bartlett, William A.; Aslan, Berna; Boned, Beatriz; Braga, Federica; Carobene, Anna; Coskun, Abdurrahman; Gonzalez-Lao, Elisabet; Jonker, Niels; Marques-Garcia, Fernando; Perich, Carmen; Ricos, Carmen; Simon, Margarita; Sandberg, SverreBackground: Biological variation (BV) data can be used to set analytical performance specifications (APS) for lipid assays. Poor performance will impact upon the efficacy of international guidelines for cardiovascular risk assessment (CVR) and relevant clinical decision limits. This systematic review applies the Biological Variation Data Critical Appraisal Checklist (BIVAC) to published studies of BV of CVR biomarkers enabling metanalysis of the data. Methods: Studies of BV of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins A(1) and B, retrieved using a systematic literature search, were evaluated and graded using the BIVAC. Meta analysis of CV1 and CVG estimates were performed utilizing weightings based upon BIVAC grades and the width of the data confidence intervals. Results: Applying the BIVAC, ten publications were graded as D, 43 as C, 5 as B and 1 as A (fully compliant). A total of 196 CV1 and 87 CVG estimates were available for the different lipid measurands. The meta-analysis-derived BV data estimates were generally concordant with those in the online 2014 BV database. Conclusions: Application of BIVAC identifies BV data suitable for many important applications including setting APS. Additionally, this review identifies a need for new BIVAC compliant studies to deliver BV reference data in different subpopulations.Item Biological Variation of Cardiac Troponins in Health and Disease: A Systematic Review and Meta-analysis(OXFORD UNIV PRESS INC, 2021-01-01) Diaz-Garzon, Jorge; Fernandez-Calle, Pilar; Sandberg, Sverre; Ozcurumez, Mustafa; Bartlett, William A.; Coskun, Abdurrahman; Carobene, Anna; Perich, Carmen; Simon, Margarita; Marques, Fernando; Boned, Beatriz; Gonzalez-Lao, Elisabet; Braga, Federica; Aarsand, Aasne K.; Chem, European Federation Clinical; Database, Task Grp Biol VariationBACKGROUND: Many studies have assessed the biological variation (BV) of cardiac-specific troponins (cTn), reporting widely varying within-subject BV (CVI) estimates. The aim of this study was to provide metaanalysis-derived BV estimates for troponin I (cTnI) and troponin T (cTnT) for different sampling intervals and states of health. METHODS: Relevant studies were identified by a systematic literature search. Studies were classified according to their methodological quality by the Biological Variation Data Critical Appraisal Checklist (BIVAC). Meta-analyses of BIVAC-compliant studies were performed after stratification by cTn isoform, exclusion of results below the limit of detection, states of health, and sampling interval to deliver reference change values (RCV), index of individuality (II) and analytical performance specifications (APS) for these settings. RESULTS: Sixteen and 15 studies were identified for cTnI and cTnT, respectively, out of which 6 received a BIVAC grade A. Five studies had applied contemporary cTnI assays, but none contemporary cTnT. High-sensitivity (hs-) cTnI and cTnT delivered similar estimates in all settings. Long-term CVI estimates (15.1Item The EuBIVAS Project: Within- and Between-Subject Biological Variation Data for Serum Creatinine Using Enzymatic and Alkaline Picrate Methods and Implications for Monitoring(AMER ASSOC CLINICAL CHEMISTRY, 2017-01-01) Carobene, Anna; Marino, Irene; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, Ibrahim; Guerra, Elena; Bartlett, William A.; Sandberg, Sverre; Aarsand, Aasne Karine; Sylte, Marit Sverresdotter; Roraas, Thomas; Solvik, Una Orvim; Fernandez-Calle, Pilar; Diaz-Garzon, Jorge; Tosato, Francesca; Plebani, Mario; Jonker, Niels; Barla, Gerhard; Ceriotti, Ferruccio; Variation, E.F.L.M. Working Grp BiolBACKGROUND: The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) European Biological Variation Study (EuBIVAS) has been established to deliver rigorously determined biological variation (BV) indices. EuBIVAS determined BV for serum creatinine using the enzymatic and alkaline picrate measurement methods. METHOD: In total, 91 healthy individuals (38 males, 53 femalesItem The EuBIVAS: Within- and Between-Subject Biological Variation Data for Electrolytes, Lipids, Urea, Uric Acid, Total Protein, Total Bilirubin, Direct Bilirubin, and Glucose(AMER ASSOC CLINICAL CHEMISTRY, 2018-01-01) Aarsand, Aasne K.; Diaz-Garzon, Jorge; Fernandez-Calle, Pilar; Guerra, Elena; Locatelli, Massimo; Bartlett, William A.; Sandberg, Sverre; Roraas, Thomas; Ceriotti, Ferruccio; Solvik, Una Orvim; Sylte, Marit Sverresdotter; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, Ibrahim; Tosato, Francesca; Plebani, Mario; Jonker, Niels; Barla, Gerhard; Carobene, Anna; Chem, European Federation ClinicalBACKGROUND: The European Federation of Clinical Chemistry and Laboratory Medicine European Biological Variation Study (EuBIVAS) has been established to deliver rigorously determined data describing biological variation (BV) of clinically important measurands. Here, EuBIVAS-based BV estimates of serum electrolytes, lipids, urea, uric acid, total protein, total bilirubin, direct bilirubin, and glucose, as well as their associated analytical performance specifications (APSs), are presented. METHOD: Samples were drawn from 91 healthy individuals (38 male, 53 femaleItem The European Biological Variation Study (EuBIVAS): a summary report(WALTER DE GRUYTER GMBH, 2022-01-01) Carobene, Anna; Aarsand, Aasne K.; Bartlett, William A.; Coskun, Abdurrahman; Diaz-Garzon, Jorge; Fernandez-Calle, Pilar; Guerra, Elena; Jonker, Niels; Locatelli, Massimo; Plebani, Mario; Sandberg, Sverre; Ceriotti, FerruccioBiological variation (BV) data have many important applications in laboratory medicine. Concerns about quality of published BV data led the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) 1st Strategic Conference to indicate need for new studies to generate BV estimates of required quality. In response, the EFLM Working Group on BV delivered the multicenter European Biological Variation Study (EuBIVAS). This review summarises the EuBIVAS and its outcomes. Serum/plasma samples were taken from 91 ostensibly healthy individuals for 10 consecutive weeks at 6 European centres. Analysis was performed by Siemens ADVIA 2400 (clinical chemistry), Cobas Roche 8000, c702 and e801 (proteins and tumor markers/hormones respectively), ACL Top 750 (coagulation parameters), and IDS iSYS or DiaSorin Liaison (bone biomarkers). A strict preanalytical and analytical protocol was applied. To determine BV estimates with 95\% CI, CV-ANOVA after analysis of outliers, homogeneity and trend analysis or a Bayesian model was applied. EuBIVAS has so far delivered BV estimates for 80 different measurands. Estimates for 10 measurands (Non-HDL Cholesterol, S100-beta protein, neuron-specific enolase, soluble transferrin receptor, intact fibroblast growth-factor-23, uncarboxylated-unphosphorylated matrix-Gla protein, human epididymis protein-4, free, conjugated and \%free prostate-specific antigen), prior to EuBIVAS, have not been available. BV data for creatinine and troponin I were obtained using two analytical methods in each case. The EuBIVAS has delivered high-quality BV data for a wide range of measurands. The BV estimates are for many measurands lower than those previously reported, having an impact on the derived analytical performance specifications and reference change values.Item A checklist for critical appraisal of studies of biological variation(2014-01-01) Bartlett, William A.; Braga, Federica; Carobene, Anna; Coskun, Abdurrahman; Prusa, Richard; Fernandez-Calle, Pilar; Roraas, Thomas; Jonker, Neils; Sandberg, Sverre; Grp, Biol Variation Working; Chem, European Federation ClinicalData on biological variation are used for many purposes in laboratory medicine but concern exists over the validity of the data reported in some studies. A critical appraisal checklist has been produced by a working group established by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) to enable standardised assessment of existing and future publications of biological variation data. The checklist identifies key elements to be reported in studies to enable safe accurate and effective transport of biological variation data sets across healthcare systems. The checklist is mapped to the domains of a minimum data set required to enable this process.Item Biological Variation Estimates Obtained from 91 Healthy Study Participants for 9 Enzymes in Serum(AMER ASSOC CLINICAL CHEMISTRY, 2017-01-01) Carobene, Anna; Roraas, Thomas; Solvik, Una Orvim; Sylte, Marit Sverresdotter; Sandberg, Sverre; Guerra, Elena; Marino, Irene; Jonker, Niels; Barla, Gerhard; Bartlett, William A.; Fernandez-Calle, Pilar; Diaz-Garzon, Jorge; Tosato, Francesca; Plebani, Mario; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, Ibrahim; Ceriottil, Ferruccio; Biological, E.F.L.M. Working GrpBACKGROUND: We sought to develop estimates of biological variation (BV) for 9 enzymes in blood serum as part of the European Biological Variation Study. METHODS: Ninety-one healthy study participants (38 male and 53 female, 21-69 years old) were phlebotomized in each of 10 consecutive weeks at 6 European laboratories. The same preanalytical sample-handling protocol was followed at each center before transport to San Raffaele Hospital, Milan, Italy, for analysis. Sera were stored at -80 degrees C before analysis in duplicate within a single run on an ADVIA 2400 Clinical Chemistry System (Siemens Healthcare) following a protocol designed to minimize analytical imprecision. Assay traceability was established using frozen sera with target values assigned by reference methods. The results were subjected to outlier analysis before CV-ANOVA to deliver valid BV estimates. Results for 9 enzymes were subsequently partitioned for graphical display allowing visual assessment of the effects of country of origin, sex, and age on BV estimates. RESULTS: We found no effect of country upon the observed variation, but overall sex-related differences were evident for alanine amino transferase (ALT), gamma-glutamyl transferase (GGT), and creatine kinase (CK). The following estimates for within-subject BV (CVI) and between-subject BV (CVG), respectively, were obtained: ALT: 9.3\%, 28.2\%Item Within- and between-subject biological variation data for tumor markers based on the European Biological Variation Study(WALTER DE GRUYTER GMBH, 2022-01-01) Coskun, Abdurrahman; Aarsand, Aasne K.; Sandberg, Sverre; Guerra, Elena; Locatelli, Massimo; Diaz-Garzon, Jorge; Fernandez-Calle, Pilar; Ceriotti, Ferruccio; Jonker, Niels; Bartlett, William A.; Carobene, Anna; Chem, European Federation ClinicalObjectives: Reliable biological variation (BV) data are required for the clinical use of tumor markers in the diagnosis and monitoring of treatment effects in cancer. The European Biological Variation Study (EuBIVAS) was established by the EFLM Biological Variation Working Group to deliver BV data for clinically important measurands. In this study, EuBIVAS-based BV estimates are provided for cancer antigen (CA) 125, CA 15-3, CA 19-9, carcinoembryonic antigen, cytokeratin-19 fragment, alpha-fetoprotein and human epididymis protein 4. Methods: Subjects from five European countries were enrolled in the study, and weekly samples were collected from 91 healthy individuals (53 females and 38 malesItem Harmonization initiatives in the generation, reporting and application of biological variation data(2018-01-01) Aarsand, Aasne K.; Roraas, Thomas; Bartlett, William A.; Coskun, Abdurrahman; Carobene, Anna; Fernandez-Calle, Pilar; Jonker, Niels; Diaz-Garzon, Jorge; Braga, Federica; Sandberg, Sverre; Chem, European Federation ClinicalBiological variation (BV) data have many applications in laboratory medicine. However, concern has been raised that some LW estimates in use today may be irrelevant or of unacceptable quality. A number of initiatives have been launched by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and other parties to deliver a more harmonized practice in the generation, reporting and application of BV data. Resulting from a necessary focus upon the veracity of historical BV studies, critical appraisal and meta-analysis of published BV studies is possible through application of the Biological Variation Data Critical Appraisal Checklist (BIVAC), published in 2017. The BIVAC compliant large-scale European Biological Variation Study delivers updated high-quality BV data for a wide range of measurands. Other significant developments include the publication of a Medical Subject Heading term for BV and recommendations for common terminology for reporting of BV data. In the near future, global BV estimates derived from meta-analysis of BIVAC appraised publications will be accessible in a Biological Variation Database at the EFLM website. The availability of these high-quality data, which have many applications that impact on the quality and interpretation of clinical laboratory results, will afford improved patient care.