Speaker:
Dr Khosrow Adeli. Clinical Biochemistry, Laboratory Medicine & Pathobiology, University of Toronto.
Dr Adeli is a senior scientist and academic clinical biochemist with over 35 years of experience in clinical chemistry service, education, and research. He has held numerous leadership positions in the field of clinical biochemistry and laboratory medicine over the past three decades. Has an established track record in both basic and clinically oriented research in the fields of metabolic health & disease as well as clinical biochemistry and pediatric laboratory medicine. Published over 700 articles and abstracts with an h-index of 82 with >36,000 citations.
Academic achievements have been recognized nationally and internationally through several prestigious research awards. Elected as president of IFCC in 2019 and served for three years (2020-2023). Currently serving on the IFCC Executive Board as IFCC past president. Since 2015, he has served as a co-chair of the CSCC Working Group on Reference Interval Harmonization, working with laboratory directors across Canada to achieve harmonization of clinical laboratory test result interpretation and clinical decision making in hospitals and medical centres country wide.
Overview:
Several national surveys have reported wide variation in reference intervals across healthcare centres in certain regions, even those using the same analytical platform and reagents for the same assay. There is a high risk of inappropriate test result interpretation when reference intervals are not appropriately harmonized. The Canadian Society for Clinical Chemistry (CSCC) Working Group on Reference Interval Harmonization was established in 2015 to develop evidence-based harmonized/common reference intervals and support their implementation in laboratories across Canada. Harnessing the power of big data, laboratory results were collected across populations and testing platforms to derive common adult RIs for 16 biochemical markers. A novel comprehensive approach was established, including:
- Analysis of big data from community laboratories across Canada;
- Statistical evaluation of age, sex, and analytical differences;
- Derivation of hRIs using the refineR method; and
- Verification of proposed harmonized reference intervals across nine laboratories with different instrumentation using serum and plasma samples collected from healthy Canadian adults.
Harmonized RIs were calculated for all assays using the refineR method, except free thyroxine. Derived harmonized reference intervals met proposed verification criterion across nine laboratories and five manufacturers for alkaline phosphatase, albumin (BCG), chloride, LDH, magnesium, phosphate, potassium (serum), total protein (serum). Further investigation is needed for select analytes due to lower verification in one or more laboratory (albumin (BCP), calcium, total CO2, total bilirubin, sodium) or concern regarding harmonized reference intervals that were considered too wide (alanine aminotransferase, creatinine, TSH). In this presentation, we will discuss the work completed by the Working Group on Reference Interval Harmonization in Canada, challenges encountered, and future plans to support implementation.
Objectives:
At the conclusion of this session, participants will be able to:
- Gain an understanding of the challenges associated with wide variations in reference intervals across healthcare centers in certain regions, especially when using the same analytical platform and reagents for a specific assay.
- Explore the establishment and objectives of the Canadian Society for Clinical Chemistry (CSCC) Working Group on Reference Interval Harmonization, and its role in developing evidence-based, harmonized/common reference intervals for biochemical markers across laboratories in Canada.
- Learn the innovative comprehensive approach employed by the CSCC Working Group, utilizing big data from community laboratories across Canada, statistical evaluation of age, sex, and analytical differences, and the refineR method for deriving harmonized reference intervals for 16 biochemical markers.
- Assess the successful verification of proposed harmonized reference intervals across diverse laboratories and manufacturers, while identifying specific analytes that require further investigation or adjustment due to concerns about wide intervals or lower verification in specific laboratories.