Author(s): Hock B, Schwarz M, Domke I, Grunert VP, Wuertemberger M,
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Abstract AIM: To test the clinical performance of carbohydrate-deficient transferrin (\%CDT), gamma-glutamyltransferase (gamma-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 gamma-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 gamma-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, gamma-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 gamma-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 gamma-GT (83.2\%). A further enhancement of the sensitivity to 88.1\% was obtained by combination of \%CDT, gamma-GT and MCV. The diagnostic specificity of \%CDT calculated at the cut-off of 3\% was 93.5\% in patients with unspecifically increased gamma-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 gamma-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 gamma-GT and MCV.
This article was published in Addiction
and referenced in Journal of Alcoholism & Drug Dependence