Sustainable reference intervals and decision limits

Abstract Laboratory findings provide essential information for assessing the state of health. Two concepts for the classification and evaluation of the findings are central: reference intervals (RI) and clinical decision limits (CDL), which also include therapeutic target limits. The IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) with the Committee for Reference Intervals (C-RIDL) and the working group on the Global Reference Interval Database (TF-GRID) presented concepts and their sustainability with a focus on reference limits at EuroMedLab Brussels 2025. Sustainability for RIs and CDLs represents a new concept that has prerequisites like a data infrastructure and a quality and information framework. Not all of these prerequisites have been fully characterized yet, but the essential aspects are addressed in this article. Standardization with metrological traceability or, where not otherwise possible, harmonization forms the basis for sustainability of RIs and CDLs. Sustainable RIs and CDLs enhance the use and value of electronic patient records and help to establish cumulative reports.