Accuracy of Carbohydrate-Deficient Transferrin in the Detection of Excessive Alcohol Consumption: A Systematic Review

Koch, Hèlen; Meerkerk, Gert-Jan; Zaat, Joost; Ham, Maria Francisca; Scholten, R. J. P. M.; Assendelft, W.J.J.

doi:10.1093/alcalc/agh031

Cited by 57 publications

(28 citation statements)

References 56 publications

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“…In 2000, Scouller et al (3 ) reviewed test-performance data and potential causes of variation and conducted a metaanalysis that showed that commonly used methods produced diagnostic odds ratios of approximately 12, corresponding to a 40% sensitivity at a 95% specificity, but with wide confidence intervals. Since that time, additional reports and reviews have described similarly intermediate estimates of test performance (7)(8)(9)(10)(11)(12).…”

confidence: 99%

Measuring Carbohydrate-Deficient Transferrin by Direct Immunoassay: Factors Affecting Diagnostic Sensitivity for Excessive Alcohol Intake

Whitfield

Madden

et al. 2008

Clinical Chemistry

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Background: Carbohydrate-deficient transferrin (CDT) is a marker of alcohol intake that is used for detecting or monitoring alcohol-use disorders. The introduction of a new direct immunoassay for CDT justifies reevaluation of test performance and reexamination of factors affecting test diagnostic sensitivity and specificity. Methods: Individuals enrolled in twin/family studies of alcohol use and dependence provided blood samples and information on recent alcohol use. Serum CDT concentration was measured in 2 088 people with the N Latex CDT (Dade Behring) method, and CDT percentage (CDT%) was calculated as the proportion of the total transferrin concentration measured with Roche reagents. Results: Diagnostic sensitivity was low, both for comparisons of men who reported an alcohol intake of >28 drinks/week vs those who consumed ≤28 drinks/week (28% sensitivity) and for women who consumed >14 drinks/week vs those who consumed ≤14 drinks/week (18% sensitivity), at cutoff values that yielded a 95% specificity. Body mass index, variables associated with metabolic syndrome, and smoking had notable effects on the probability of an abnormal CDT result with excessive alcohol use. Diagnostic sensitivity was greater in men of normal weight (43%) than in obese men (10%) and greater in male smokers (38%) than in male nonsmokers (21%). In women, diagnostic sensitivities were ≤20%, even for those of normal weight and for smokers. Conclusions: CDT is a poor marker of excessive alcohol intake in both women and men who are overweight or obese. It is also less useful in nonsmokers than in smokers. The diagnostic performance of the direct immunoassay and the effects of obesity and smoking are similar to those reported with previous anion-exchange immunoassay methods.

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confidence: 99%

Measuring Carbohydrate-Deficient Transferrin by Direct Immunoassay: Factors Affecting Diagnostic Sensitivity for Excessive Alcohol Intake

Whitfield

Madden

et al. 2008

Clinical Chemistry

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“…While self-reported data obtained by questionnaires may underestimate alcohol intake, laboratory measures provide more objective data related to ethanol metabolism. Blood tests traditionally used in the workup of alcoholism, such as liver enzyme tests (ALT, AST, GGT) and MCV, do reflect excessive, prolonged alcohol consumption but have imperfect sensitivity and specificity [22,23]. The percentage of CDT isoforms relative to the amount of total transferrin in the serum is currently considered the most sensitive and specific indicator of chronic alcohol intake [22,24].…”

Section: Discussionmentioning

confidence: 99%

Biomarkers demonstrate increased consumption, but not abuse, of ethanol in essential tremor

et al. 2011

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Ethanol is known to improve tremor in a proportion of patients with essential tremor. Increased incidence of alcoholism has been suspected in essential tremor patients; however, no objective evaluation has been performed using laboratory markers to date. Data on alcohol intake in the last 30 days were acquired in 95 essential tremor patients and 35 healthy controls. Blood and urine markers related to alcohol metabolism and liver function were evaluated. Self-reported alcohol intake and biomarker levels were higher in essential tremor, but the difference was only significant for carbohydrate-deficient transferrin. None of the subjects presented with laboratory parameters reflecting chronic alcohol abuse. Our data do not reflect a higher incidence of alcoholism in patients with essential tremor. Their alcohol intake is well controlled and does not exceed the limits of healthy social drinking.

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“…The situation is similar with MCV, whose sensitivity and specificity are lower in relation to other alcoholism biomarkers, because its values may also be increased in liver damage, vitamin B12 and folic acid, deficiency, hematological diseases, reticulocytosis, hypothyroidism, etc. (16).…”

Section: Discussionmentioning

confidence: 99%

Carbohydrate-Deficient Transferrin - A Contemporary Biomarker in Comparison with Traditional Laboratory Markers of Chronic Alcohol Abuse

Maksić¹,

Vodnik²,

Stanković³

et al. 2010

Journal of Medical Biochemistry

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Summary: Timely identification of excessive alcohol use and its potential complications is a prerequisite for successful treatment. Several routine tests have been used in laboratories that may help in diagnosing alcoholism, such as determination of MCV, AST, ALT, GGT, but it has been shown that they lack specificity and sensitivity. Contemporary biomarkers are increasingly being used today that may due to their unique characteristics help in disco vering the onset of chronic alcohol abuse, as well as in abstinence and relapse monitoring. The term carbohydrate-deficient transferrin (CDT) stands for a small group of human transferrin isoforms (asialo, monosialo, and disialotran sferrin) with a lower degree of glycosylation in comparison to the dominant transferrin isoform (tetrasialotransferrin). Persons consuming large quantities of alcohol (≥50 -80 g daily) over a period of at least two weeks have increased concentrations of transferrin isoforms lacking one (disialo transferrin) or both (asialotransferrin) carbohydrate chains. In this paper the traditional markers of chronic alcohol abuse (GGT, AST, ALT, and MCV) were determined, as well as the new biomarker CDT, after which diagnostic evaluation was performed and their usability and clinical value in routine laboratory practice were estimated. These markers were also determined in heavy alcoholics on admission into hospital and after two weeks of therapy, with the aim of estimating their diagnostic value for abstinence and relapse monitoring. Keywords: alcoholism, biomarkers, CDT, transferrinKratak sadr`aj: Pravovremeno prepoznavanje preko merne upotrebe alkohola i potencijalnih komplika cija pred uslov je za uspe{no le~enje. U laboratorijama se koristi neko liko rutinskih testova koji mogu da pomognu u dijagnostici alkoholizma, kao npr. odre|ivanje MCV, AST, ALT, GGT, ali su se pokazali kao nedovoljno specifi~ni i osetljivi. Danas su sve vi{e u upotrebi savremeni biomarkeri koji zahvaljuju}i svojim jedin stvenim osobinama mogu da pomognu kod otkrivanja po ja ve hroni~nog alkoholizma, kao i pri pra}enju apstinencije i relapsa. Naziv transferin deficijentan ugljenim hidratima (CDT) podrazumeva manju grupu izoformi humanog trans ferina (asialo-, monosialo-i disialo-transferin), koje imaju ni`i stepen glikozilacije u pore|enju sa do minantnom izo for mom transferina (tetrasialotran sfe rin). Osobe koje unose velike koli~ine alkohola (≥50-80 g dnevno) u periodu od najmanje 2 nedelje imaju povi{ene koncentracije izoformi transferina kojima nedostaje jedan (disialotransferin) ili oba (asialotransferin) ugljeno hidratna lanca. U ovom radu oba vlje no je odre|ivanje tradicionalnih marke ra hroni~ne alko ho lne potro{nje (GGT, AST, ALT i MCV), kao i novog bio markera CDT, a zatim je izvr{ena dijagno sti~ka evaluacija i procena njihove upotrebljivosti i klini~ke vrednosti u rutin skoj laboratorijskoj praksi. Tako|e je izvr{eno odre|ivanje navedenih markera kod te{kih alkoholi~ara pri prijemu na bolni~ko odeljenje i nakon 2 nedelje terapije u cilju proce ne njihove dijag...

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Accuracy of Carbohydrate-Deficient Transferrin in the Detection of Excessive Alcohol Consumption: A Systematic Review

Cited by 57 publications

References 56 publications

Measuring Carbohydrate-Deficient Transferrin by Direct Immunoassay: Factors Affecting Diagnostic Sensitivity for Excessive Alcohol Intake

Measuring Carbohydrate-Deficient Transferrin by Direct Immunoassay: Factors Affecting Diagnostic Sensitivity for Excessive Alcohol Intake

Biomarkers demonstrate increased consumption, but not abuse, of ethanol in essential tremor

Carbohydrate-Deficient Transferrin - A Contemporary Biomarker in Comparison with Traditional Laboratory Markers of Chronic Alcohol Abuse

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