Diagnostic usefulness of carbohydrate-deficient transferrin for detecting alcohol-related problems in hospitalized patients

Abstract

We evaluated the diagnostic usefulness of carbohydrate-deficient transferrin (CDT) for detecting alcohol-related problems (ARP) in hospitalized patients, assessed potential differences according to gender and age, and compared this value to the other screening measures conventionally used, namely the CAGE questionnaire and standard biological markers MCV (mean corpuscular volume) and GGT (gamma-glutamyltransferase). CDT sensitivity for detecting ARP was 70%, specificity 75% and area under the receiver operating characteristic curve 0.76%. Its sensitivity was shown to be lower both in the female group (65 vs 71%) as well as in the younger-age group whereas its specificity was lower in the liver-damaged group (55%). CDT diagnostic value did not exceed that of CAGE (sensitivity 78% and specificity 99%), MCV (sensitivity and specificity 74%) or GGT (sensitivity 82% and specificity 53%) but was better than those of other biochemical measures. We conclude that CDT is an effective biological marker for the detection of ARP among hospitalized patients, but that its diagnostic usefulness does not exceed that of some other alternative measures commonly used.

Factors Affecting %CDT Status at Entry Into a Multisite Clinical Treatment Trial: Experience from the COMBINE Study

“…The suggested relationship between chronic severity (past treatment episodes) and %CDT positives is consistent with reports that younger individuals who drink heavily might have lower %CDT-positive values (Gomez et al, 2001;Huseby et al, 1997) than older individuals, unless they have many more years of alcohol abuse/ dependent drinking (Huseby et al, 1997). It is well known that adolescent and young adults drink in a ''binge pattern'' such that weekend heavy drinking is more likely.…”

“…It has been speculated that this might be due to a liver ''sensitization'' effect after many years of heavy alcohol use. This idea is supported to some degree by more infrequent CDT elevation in younger heavy drinkers both under clinical (Gomez et al, 2001;Huseby et al, 1997) and experimental (Lesch et al, 1996) conditions.…”

Traditional markers of excessive alcohol use

“…Sensitivity is similar in psychiatric in-patients (36%, specificity 87%) [17]. Sensitivity increases in medical in-patients (30-83%) [18][19][20][21] but non-alcohol-related illness and medication complicate interpretation of elevated test results, and accordingly specificities range from 75% down to 50% [18,19]. In residential alcoholism treatment units, sensitivity may be high (50-90%), with reasonable specificity (65-90%) [22][23][24][25][26] but in this setting a screening test is not needed.…”

Carbohydrate-Deficient Transferrin: Validity of a New Alcohol Biomarker in a Sample of Patients with Diabetes and Hypertension

“…16 CDT is also widely used in Europe to monitor abstinence, assess preoperative alcohol risk, and identify high-risk drinking in surgical and medical settings. [17][18][19][20][21] The goal of the study was to determine the reliability and validity of %CDT levels in a sample of primary care patients being treated with medication for type 2 diabetes and/or hypertension using well-validated patient self-report as the criterion standard. This is the first large-scale study of CDT in general medical care settings in the United States.…”