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The reference change value, defined as RCV=1.96×2  1/2 ×(s  I  2 +s  A  2 )  1/2 , where s  I  is within-subject biological variation and s  A  is analytical variation, has been used for many years to take clinical decisions in patient monitoring. Furthermore, the index of individuality was defined as II=(s  I  2 +s  A  2 )  1/2 /s  G , where s  G  is the between-subject biological variation. This index has been simplified by later authors to s  I /s  G  and has been used in monitoring situations to determine the utility of population-based reference intervals. Harris stated that when the index of individuality is lower than 0.6, the specific reference interval of the individual – when available – is better than the population-based reference interval. However, if a change within a patient is equivalent to the RCV applied for the significant difference between two measurements, the probability of detecting this change is only 50% (the same probability of missing it). Therefore, to obtain a higher probability of detecting a change by the RCV (e.g., 90%) the interpretation of the index of individuality has to be reconsidered. This contribution compares the power of the RCV to the use of cut-off points and population-based reference intervals. The benefits of the RCV compared to the distance to cut-off point or reference limit are also described in relation to the index of individuality.

Power function of the reference change value in relation to cut-off points, reference intervals and index of individuality