Comparison of Univariate and Multivariate Reference Interval Methods

Background: In clinical practice, reference intervals play a pivotal role in interpreting laboratory test results. Yet, when several tests are taken into consideration simultaneously, the traditional univariate intervals might not suffice due to the elevated risk of Type 1 errors. Methods: This study introduces and evaluates two multivariate reference interval techniques: one based on Mahalanobis distance and the other an adaptation of the multivariate confidence interval (MCI). Using Monte Carlo simulations, we focused our assessments on the interplay between “serum ferritin and transferrin saturation” values. Results: Upon evaluation, it became evident that the multivariate methods significantly reduced false positives. They presented enhanced accuracy over traditional univariate intervals. Notably, the method involving Mahalanobis distance stood out in terms of efficacy. Contributions: Beyond presenting novel techniques, our research underscores the importance and potential of using multivariate approaches in clinical lab settings. The findings can guide better medical decision making, ensuring optimized allocation of healthcare resources.