Clinical outcome estimates based on treatment target limits of laboratory tests: proposal for a plot visualizing effects and differences of medical target setting exemplified by glycemic control in diabetes

Clinical Chemistry and Laboratory Medicine : CCLM
Lone G M JørgensenIvan Brandslund

Abstract

In modern medicine many laboratory measurements are used as a surrogate for clinical outcome. There is therefore a need for models to quantify this approach. The target plot presented here is based on the difference plot. The difference between two measurements is plotted against the initial measurement, of which the first measurement is the index measurement (Mindex) and the second the outcome measurement (Moutcome). A vertical line separates normal vs. increased Mindex concentrations according to a selected target concentration, and a horizontal line describes the situation of no change. A target line (Mtarget) with a slope equal to -1 and indicating the selected target concentration is drawn through the crossing point. The six outcome areas thus refer to the combined effect of Mindex and Moutcome. A target plot taking the biological and analytical variation in consideration is considered. MATERIALS AND MODEL: The target plot addresses sources of outcome categories, and calculates the percentage in each of these categories according to a defined target value. Hemoglobin A1c (HbA1c) in diabetes in patients from Vejle County, Denmark was taken as an example. Different strategies for target setting for HbA1c were investigated: t...Continue Reading

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Citations

Mar 4, 2011·Clinical Chemistry and Laboratory Medicine : CCLM·Greg CooperMario Plebani
Jun 22, 2013·American Journal of Ophthalmology·Friederike MackensenMatthias D Becker
Sep 21, 2012·Clinical Chemistry and Laboratory Medicine : CCLM·Philippe Gillery

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