The biological variation data critical appraisal checklist: A standard for evaluating studies on biological variation

Aasne K. Aarsand (Lead / Corresponding author), Thomas Røraas, Pilar Fernandez-Calle, Carmen Ricos, Jorge Díaz-Garzón, Niels Jonker, Carmen Perich, Elisabet González-Lao, Anna Carobene, Joana Minchinela, Abdurrahman Coşkun, Margarita Simón, Virtudes Álvarez, William A. Bartlett, Pilar Fernández-Fernández, Beatriz Boned, Federica Braga, Zoraida Corte, Berna Aslan, Sverre Sandberg

Research output: Contribution to journalArticlepeer-review

131 Citations (Scopus)


Background: 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.

Original languageEnglish
Pages (from-to)501-514
Number of pages14
JournalClinical Chemistry
Issue number3
Early online date28 Feb 2018
Publication statusPublished - 1 Mar 2018

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical


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