Authors: Hock, B.; Schwarz, M.¹; Domke, I.²; Grunert, V. P.²; Wuertemberger, M.²; Schiemann, U.³; Horster, S.⁴; Limmer, C.¹; Stecker, G.¹; Soyka, M.¹

Source: Addiction, Volume 100, Number 10, October 2005 , pp. 1477-1486(10)

Publisher: Wiley-Blackwell

Abstract:

Aim

To test the clinical performance of carbohydrate-deficient transferrin (%CDT), -glutamyltransferase (-GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for alcoholism with a special focus on patients suffering from liver diseases. Design

Well-characterized collectives of alcohol-dependent patients with current consumption (ALC patients, n = 101), and relevant control groups (115 social drinkers, 46 patients with unspecifically increased -GT, 51 hepatitis patients and 20/31 patients with non-alcohol/alcohol-dependent liver cirrhosis) were included into the study. The Positive Alcohol Use Disorders Test (AUDIT) score, International Classification of Diseases version 10 (ICD-10)/Diagnostic and Statistical Manual version IV (DSM-IV) criteria and blood drawn within 4 days of last drinking were inclusion criteria for subjects with regular heavy drinking. %CDT was determined using an automated assay which recently had been completely modified. Findings

Median AUDIT scores of patients without/with regular heavy drinking were 1–3/27. The following medians/95th percentiles were obtained for %CDT: social drinkers 2.2/3.0, patients with unspecifically increased -GT 2.1/3.0, hepatitis 2.0/4.4, non-alcohol-dependent liver cirrhosis 2.4/4.8, alcohol-dependent liver cirrhosis 3.0/5.9, ALC patients 3.9/14.9. Differences between patients without and with alcohol abuse were highly significant (P < 0.001). No differences in CDT values were found between males and females. There was no correlation between %CDT values, -GT, MCV and the amount of alcohol consumed in ALC patients; 3.0%CDT (95th percentile social drinkers) is proposed as cut-off for the test used (Tina-quant^®%CDT 2nd-generation). At this cut-off, the sensitivity for ALC patients was 73.3%, whereas -GT/MCV had a sensitivity of 71.3%/64.4%. Multivariate analysis performed at 95% specificity resulted in an improvement of the sensitivity by combining %CDT with -GT (83.2%). A further enhancement of the sensitivity to 88.1% was obtained by combination of %CDT, -GT and MCV. The diagnostic specificity of %CDT calculated at the cut-off of 3% was 93.5% in patients with unspecifically increased -GT, 88.2% in hepatitis patients and 70.0% in patients with non-alcohol-dependent liver cirrhosis. %CDT was more specific in these patient collectives than MCV, and especially more than -GT (specificity in hepatitis 52.9%, and 35.0% in non-alcohol-dependent liver cirrhosis). Conclusion

%CDT is of high diagnostic value to support diagnosis of alcohol-use disorders. The specificity of this marker in patient groups with liver disorders is superior to the biomarkers -GT and MCV.

Keywords: Carbohydrate-deficient transferrin (% CDT); chronic alcohol abuse; diagnostic sensitivity; diagnostic specificity; -glutamyltransferase; liver diseases; mean corpuscular volume

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1360-0443.2005.01216.x

Affiliations: 1: Psychiatric Clinic of Ludwig-Maximilian-University, Munich, Germany 2: Roche Diagnostics GmbH, Mannheim/Penzberg, Germany 3: Clinic of Internal Medicine of Ludwig-Maximilian-University, Munich, Germany 4: Hepatitis Outpatient Clinic of Ludwig-Maximilian-University, Munich, Germany

Publication date: 2005-10-01

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