Figure 1

Ability of erythrocyte protoporphyrin, either alone or combined with haemoglobin concentration, to discriminate between pregnant women with and without iron deficiency. (Panel A) Receiver operating characteristics (ROC) curve for various blood markers, used alone, to discriminate between iron-deficient and iron-replete women. Area-under-the-curve (AUC; 95% CI): whole blood ZPP: (0.66; 0.57–0.74); erythrocyte ZPP: (0.73; 0.65–0.80); EP: (0.59; 0.50–0.68); haemoglobin concentration: (0.61; 0.52–0.70). (Panel B) Cumulative relative frequency distribution of erythrocyte ZPP, the best indicator when used as a single test (Panel A) to discriminate between iron-deficient and iron-replete women. The black circle in Panel A and the dotted black line in Panel B indicate the erythrocyte ZPP:haem ratio of 34 μmol/mol whereby the total diagnostic error is minimised at a prevalence of iron deficiency of 50%. (Panels C, E, and G) ROC curves for whole blood ZPP, erythrocyte ZPP, and EP, either alone or each in combination with haemoglobin concentration. AUC; 95% CI: combined whole blood ZPP with haemoglobin concentration: (0.64; 0.56–0.73); combined erythrocyte ZPP with haemoglobin concentration: (0.72; 0.64–0.80); combined EP with haemoglobin concentration: (0.64; 0.55–0.73). (Panel D) Bivariate scatterplot for whole blood ZPP and haemoglobin concentration, by iron status; (Panel F) Bivariate scatterplot for erythrocyte ZPP and haemoglobin concentration, by iron status; (Panel H) Bivariate scatterplot for EP and haemoglobin concentration, by iron status. Grey dashed lines in ROC curves indicate a ‘worst’ possible test, which has no discriminatory value and an area-under-the-curve (AUC) of 0.5. An ideal marker would have a curve that runs from the lower-left via the upper-left to the upper-right corner, yielding an AUC of 1.0.