Carbohydrate-Deficient Transferrin as a Marker of Alcohol Consumption in Male Patients with Liver Disease

Carbohydrate-deficient transferrin (CDT) has been proposed as a marker of alcohol abuse. However, its value in patients with associated liver disease is still controversial. The aim of the study was to investigate the usefulness of CDT as a marker of alcohol consumption in patients with liver disease. We measured serum levels of CDT and those of commonly used hematological and biochemical markers, mean corpuscular volume (MCV), transaminases (AST and ALT), and γ-glutamyltransferase in 179 male subjects divided into four groups: 45 active drinkers (13 with normal liver, 21 with fibrosteatosis, and 11 with liver cirrhosis), 45 abstinent chronic alcoholics (18 with and 27 without liver disease), 58 patients with nonalcoholic liver disease, and 31 healthy controls. Serum CDT in active alcoholics was 37.5 ± 3.6 units/liter, being significantly higher than that of abstinent alcoholics (20.3 ± 1.5 units/liter), patients with nonalcoholic liver disease (18.1 ± 1.1 units/liter), and controls (13.1 ± 0.8 units/liter). Contrary to the other markers, no significant differences were observed in CDT values in relation with the presence and severity of liver disease in either the active drinkers or in the abstinent alcoholics. The sensitivity and specificity of CDT as a marker of alcoholism in the series as a whole was 64% and 82%, respectively, similar to the best conventional marker, MCV (64 and 82%). In patients with liver disease, CDT maintained good sensitivity (72%) and specificity (83%). Receiver operating characteristic analysis confirmed that CDT had a similar diagnostic value to that of MCV, but better than γ-glutamyltransferase and transaminases for the detection of alcohol abusers. The good diagnostic efficacy of CDT remained unchanged when analyzing only patients with liver disease. We conclude that serum CDT is a good marker of alcoholism and is less influenced than the currently used biochemical markers for associated liver disease. Thus, CDT is an effective laboratory test to detect alcohol abuse regardless of the presence of alcoholic liver disease.     

Carbohydrate-Deficient Transferrin During 3 Weeks' Heavy Alcohol Consumption

To study the effect of controlled heavy drinking of 60 g ethanol/day for 3 weeks on carbohydrate-deficient transferrin (CDT), a commercial double antibody kit (CDTect™) was used. By the end of the third drinking week, a statistically significant increase in the mean CDT level was observed. When compared to AST and γ-glutamyltransferase, CDT was a more informative marker. However, only in 2 of the 10 volunteers did CDT exceed the upper normal level (20 units/liter) recommended by the manufacturer. This indicates that the sensitivity of CDT to detect heavy drinking is lower than that previously reported. The higher accuracy has in general been obtained in studies comparing healthy controls with a low alcohol consumption to alcoholics with an alcohol consumption higher than that used in the present experiment. Our results suggest that it remains to be established whether CDT, although better than AST and γ-glutamyltransferase, will provide a clinically useful tool in identifying heavy drinkers in populations covering a wide range of alcohol consumption.     

Serum Carbohydrate-Deficient Transferrin as a Marker of Alcohol Consumption in Patients with Chronic Liver Diseases

We meesured serum levels of carbohydrate deficient transferrin (CDT) in 420 subjects: 100 healthy blood donors, 82 healthy employses, 70 abstaining patients with different chronic nonalcoholic liver disease, 16 abstaining patients with alcoholic fatty liver, 50 abstaining patients with alcohotic liver cirrhosls, 25 abusing patients with alcoholic fatty liver, 41 abusing patients with alcoholic liver cirrhosis, and 36 patients with alcohol dependence syndrome with a daily ethanol consumption of 173 ± 120 g the last 4 weeks before blood was drawn. In controls the serum level of CDT was significantly higher in females compared with males (17.7 ± 5.1 and 13.7 ± 3.8 units/liter, respectively), and the upper normal limit was defined as 27 and 20 units/liter. Sixty-two of 102 (60.8%) abusing patients with alcoholic liver disease had increased levels of CDT compared with 1 of 66 abstaining (1.5%) patients with alcoholic liver disease, and 10 of 70 (14.3%) abstaining patients with nonalcoholic liver disease among them 3 with primary biliary cirrhosis and 2 with chronic autoimmune hepatitis. No correlation was found between serum CDT and γ-glutamyltranspeptidase (GGT), AST, ALT, and mean red cell volume (MCV). The sensitivity and specificity for serum CDT was 61 and 92%, respectively, compared with 85 and 18% for GGT and 70 and 66% for MCV. No advantage was gained by using the CDT/transferrin ratio. Our study confirms that CDT is a specific marker for chronic alcohol abuse, except in few patients with other chronic liver diseases. Serum CDT seems to be a better indicator of abstention than GGT; AST and MCV in patients with alcoholic liver disease. However, in our hands CDT is not so sensitive for alcohol abuse in patients with liver disease as reported earlier in unselected alcoholics     

Sensitivity and Specificity of Carbohydrate-Deficient Transferrin as a Marker of Alcohol Abuse Are Significantly Influenced by Alterations in Serum Transferrin: Comparison of Two Methods

Despite a number of investigations suggesting the value of carbohydrate-deficient transferrin (CDT) as a marker of alcohol abuse, a variety of issues on the applicability of CDT measurements in clinical settings have remained unexplored. Earlier studies in this field have focused on the relationship of CDT and the amount of alcohol consumption or presence of liver disease, whereas the influence of alterations in serum transferrin concentrations on CDT has received less attention. In this study, we compared two different methods for measuring CDT (CDTect and %CDT) and total transferrin concentrations in a sample of 83 alcohol abusers (20 patients with alcoholic liver disease and 63 heavy drinkers who were devoid of liver disease, despite excessive alcohol consumption) and 89 controls, who were social drinkers or abstainers. The control population included 53 hospitalized patients with expected abnormalities in serum transferrin concentrations caused by conditions such as negative iron balance, pregnancy, or nonalcoholic liver disease. Both methods gave significantly higher values in alcohol abusers than in controls (p < 0.01), but the overall sensitivity for detecting alcohol abuse was clearly higher for CDTect (59%) than for %CDT (34%). The correlation between the results obtained by the two methods (r= 0.629) significantly improved, when the CDTect values were replaced by the ratio of CDTect/total transferrin (r= 0.770) (p < 0.05). There was a positive correlation between the CDTect and serum transferrin (r= 0.201, p < 0.01), which was significant both in the alcoholics (r= 0.240, p < 0.05), and especially in the controls (r= 0.727, p < 0.001). A significant inverse correlation emerged between %CDT and total transferrin (r= -0.302, p < 0.01). The sensitivities of CDTect and %CDT for correctly classifying alcohol abusers in the subgroup of alcoholic liver disease patients were 90% and 70% and in the subgroup of heavy drinkers without liver disease (49% and 22%), respectively. Specificities for CDTect and %CDT in this sample were 81% and 100%, respectively. However, in the subgroup of hospitalized control patients with abnormal serum transferrin, the specificity of CDTect was only 48%. According to present data, CDTect seems to be more sensitive than %CDT for detecting alcohol abuse. However, any alteration in serum total transferrin concentration markedly decreases the assay specificity. This should be considered when interpreting the assay results in patients with elevated serum transferrin, such as iron deficiency, pregnancy, or liver diseases.     

Does Carbohydrate-Deficient Transferrin Predict the Severity of Alcohol Withdrawal Syndrome?

Alcohol withdrawal often causes severe complications. However, many addicts deny any abuse. Thus, the diagnosis of alcohol abuse frequently becomes difficult. Laboratory parameters are often used to support the diagnosis of alcohol abuse. Furthermore, laboratory parameters should facilitate the prediction of the severity of alcohol withdrawal syndrome (AWS). The most promising laboratory parameter indicating a recent elevated alcohol consumption is carbohydrate-deficient transferrin (CDT). The aim of this study was to examine whether the measurement of CDT at admission can indicate a higher risk for the development of a complicated AWS. The severity of AWS was assessed by the AWS scale, consisting of two subscales for somatic and mental symptoms. CDT was measured by different methods (radioimmunoassay and HPLC). The radioimmunoassay for CDT (CDTect) yielded the best prediction. Our results showed a weak correlation between CDTect and the severity of AWS. However, there were great gender differences. In men, CDTect had the highest positive predictive value for a severe AWS (86.7%), whereas in women mean corpuscular volume was the best predictor (77.8%). However, the sensitivity of CDTect in men (25.5%), as well as mean corpuscular volume in females (29.2%), was too low for a screening test in a general hospital.     

Carbohydrate-Deficient Transferrin and Other Markers of High Alcohol Consumption: A Study of 502 Patients Admitted Consecutively to a Medical Department

An isoform of transferrin, carbohydrate-deficient transferrin (CDT) is increased in a high percentage of abusing alcoholics and has been found superior in its specificity compared with other biological markers. We used serum CDT as a screening parameter in 502 patients consecutively admitted to our medical department during a 4-week period. The intake of ethanol during the last 4 weeks was registrated by personal interviews and the mean daily consumption calculated. Serum CDT was measured at admission (CDTect) and compared with γ-glutamyltranspeptidase (GGT), AST, ALT, and mean corpuscular volume (MCV). Serum CDT detected 18 of 26 (69%) patients who consumed >50 g ethanol daily. The clinical sensitivity of CDT of detection ethanol consumption >50 g daily was 69%, compared with 73%, 50%, 35%, and 52% for increased values of GGT, AST, ALT, and MCV, respectively. Altogether, 38 of 476 patients (8%) with a daily ethanol consumption < 50 g also had increased serum CDT levels. The specificity of CDT was 92%, compared with 75%, 82%, 86%, and 85% for GGT, AST, ALT, and MCV, respectively. In the 60 patients who consumed >10 g ethanol daily, we found a significantly positive correlation between CDT and ethanol consumption ( r = 0.52, p < 0.001). A positive correlation was also found between serum transferrin and CDT ( r = 0.51, p < 0.001). In conclusion, the specificity of CDT is much higher compared with GGT in detecting alcohol abuse. Some acute and chronic illnesses may increase the serum level of CDT. False-positive CDT levels may be caused by changes in serum transferrin concentration.     

Carbohydrate-Deficient Transferrin in Alcohol and Nonalcohol Abusers with Liver Disease

Carbohydrate-deficient transferrin (CDT) has been demonstrated to be a marker of prolonged heavy alcohol consumption. We compared this marker with γ-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV) in alcohol and nonalcohol abusers with liver disease. Our results confirm that the sensitivity of CDT in alcoholics is high, although lower than that of GGT and MCV; however, the specificity of CDT was higher than that of the other two markers. This finding supports the notion that CDT is only partially influenced by the presence of liver damage, whereas increases of GGT and MCV are greatly affected by several factors, including liver damage and drugs. Moreover, we observed that the sensitivity and the specificity of CDT were greater than those of GGT and MCV in younger drinkers.     

Is Carbohydrate-Deficient Transferrin a Specific Marker for Alcohol Abuse? A Study in Patients with Chronic Viral Hepatitis

Carbohydrate-deficient transferrin, a transferrin isoform, is hailed as a new marker of chronic alcohol abuse, but its specificity is, however, not unequivocally accepted. The aim of the present study was therefore to determine carbohydrate-deficient transferrin levels in patients with chronic hepatitis B and C with or without documented chronic alcohol intake. Carbohydrate-deficient transferrin was measured using a double-antibody radioimmunoassay (CDTect^TM, Pharmacia®) in serum samples from 66 patients (45 males and 21 females; mean age: 39 years) with chronic viral hepatitis B ( n = 20) or C ( n = 46). Diagnosis of the underlying liver disease was established by liver biopsy. Carbohydrate-deficient transferrin levels were raised in 15 patients [23%; hepatitis B ( n = 2) and hepatitis C ( n = 13)]. In patients with chronic hepatitis B, the carbohydrate-deficient transferrin level was raised in two abstainers. In the 46 patients with chronic hepatitis C, 10 (22%) patients with an alcohol consumption of > 60 g/day for the men and 30 g/day for the women had raised carbohydrate-deficient transferrin levels. The overall specificity of carbohydrate-deficient transferrin for chronic alcohol abuse was thus 78%, suggesting an association between elevated carbohydrate-deficient transferrin levels and the presence of chronic viral hepatitis. Carbohydrate-deficient transferrin levels were not correlated with the histological grading or staging of chronic hepatitis B and C, or with biological markers of hepatic synthesis and cellular damage. Thus, an increased carbohydrate-deficient transferrin level may occur in patients with chronic viral hepatitis in the absence of chronic alcohol abuse. This fact should be kept in mind by physicians when using this marker to detect alcohol abuse.     

Carbohydrate-Deficient Transferrin as a Marker of Change in Alcohol Intake in Men Drinking 20 to 60 g of Alcohol Per Day

We evaluated carbohydrate-deficient transferrin (CDT) and γ-glutarnyltranspeptidase (γ-GT) as markers of alcohol intake and change in alcohol intake in white Australian men aged 20 to 63 years who regularly drank 20 to 60 g of alcohol/day (2 to 6 standard drinks), either as weekend (n = 14) or daily drinkers (n = 41). After 4 weeks of familiarization on usual alcohol intake, men were provided with low alcohol beer (24 times 375 ml cans, 0.9%, v/v, two-weekly), and, for 4 weeks, consumed as much or as little as they wished with no additional alcohol permitted. In an alternate 4-week period, the same amount of full-strength beer (4.9%, v/v) was provided, whereas subjects continued their usual amount and pattern of alcohol consumption. The order of experimental conditions was randomized. Retrospective 7-day diaries documented weekly alcohol intake during 4 weeks of familiarization and 8 weeks of intervention. Mean alcohol intake was 345 g/week of alcohol (SD 97) during familiarization. During the last 4 weeks of intervention (study weeks 8 to 12), mean alcohol intake either increased by 360 g/week (SD 138) with the switch from low to high alcohol or decreased by 328 g/week (SD 120) with the reverse. During familiarization (study weeks 1 to 4), alcohol intake was significantly related independently (R²= 0.21) to mean corpuscular volume (ρ= 0.008) and uric acid (ρ= 0.003), but not to γ-GT (ρ= 0.22) nor CDT (p = 0.94). Change in alcohol intake was predicted independently (R²= 0.60) by change in CDT (ρ < 0.0001) and γ-GT (ρ= 0.0003), but not by change in uric acid or mean corpuscular volume. A 10% change in CDT gave 70% sensitivity and 80% specificity to detect a change of at least 2 standard drinks/day; respective values were 68% and 0 for 10% change in γ-GT. Results were not related to drinking pattern, smoking, age, or weight CDT, particularly when used as a continuous variable, may have a place in monitoring alcohol consumption, even in men whose alcohol intake is in the 20 to 60 g/day range.     

Carbohydrate-Deficient Transferrin as an Alcohol Marker among Female Heavy Drinkers: A Population-Based Study

Carbohydrate-deficient transferrin (CDT) has previously been reported to be an excellent marker of male alcoholics. Less is known of its efficiency among women and especially of early-phase alcohol abuse in nonselected populations. The present population-based study examined the diagnostic value of CDT among consecutive women, including 13 teetotallers, 135 social drinkers (mean alcohol consumption 45 ± 34 g/week), and 57 nonalcoholic heavy drinkers (197 ± 97 g/week). Sixty-two women with a well-documented history of chronic alcoholism (942 ± 191 g/week) were also studied, as well as 36 pregnant women used as a reference group. Two weeks of abstinence among 11 alcoholics was followed. The CDT (containing part of isotransferrin with pl = 5.7, 5.8, and 5.9) was separated by anion exchange chromatography and assayed by radioimmunoassay. In the whole material, CDT correlated significantly with alcohol consumption (r= 0.43, p < 0.001) but not with conventional markers (γ-glutamyltransferase, AST, ALT, and mean corpuscular volume). The CDT values of alcoholics (34 ± 20 units/liter) were significantly (p < 0.001) higher than those of teetotallers (19 ± 6 units/liter), social drinkers (20 ± 6 units/liter), or pregnant women (16 ± 13 units/ liter). Heavy drinkers also had higher values (25 ± 13 units/liter), but the difference did not reach statistic significance. The specificity of CDT was on the level of conventional markers when the cut-off value was increased from 26 to 29 units/liter. At a specificity of 95%, CDT found 19% of the heavy drinkers and 52% of the alcoholics; the best traditional marker, AST, with a specificity of 97%, found 7% and 56%, respectively. CDT was useful for follow-up of alcohol withdrawal when its initial value was elevated. In general, CDT (as well as conventional laboratory markers) does not seem to be sensitive enough in the detection of alcohol abuse in the female population. This is especially clear among nonalcoholic female heavy drinkers. CDT gives, however, additional information about alcohol abuse, and it may be recommended for parallel use with conventional markers in clinical use.     

Comparison of Carbohydrate-Deficient Transferrin, Immunoglobulin A Antibodies Reactive with Acetaldehyde-Modified Protein and Acetaldehyde-Modified Albumin with Conventional Markers of Alcohol Consumption

Carbohydrate-deficient transferrin (CDT) has emerged as the best new marker for alcohol abuse. Recently plasma immunoglobulin A (IgA) reactivity with acetaldehyde (AcH)-modified proteins, or the modified proteins per se, have been proposed as a markers for high levels of alcohol consumption. In this study, we have compared CDT, IgA reactivity with AcH adducts (IgA ASR), and AcH-modified albumin with conventional markers of high alcohol intake in groups with well-defined drinking histories. The plasma activity of ALT, AST, and γ-glutamyltransferase increased steadily with increasing alcohol consumption. CDT and AcH-modified albumin showed a similar pattern, whereas IgA ASR appeared only to be elevated after a threshold level of consumption had been reached. Neither CDT IgA ASR or AcH-modified albumin correlated strongly with any of the conventional markers or each other. This study shows that CDT, IgA ASR, AcH-modified albumin, and the conventional markers are not related, but suggests that the concurrent use of CDT and IgA ASR may lead to better identification of high alcohol intake.     

Carbohydrate-Deficient Transferrin: Diagnostic Efficiency Among Patients with End-Stage Liver Disease Before and After Liver Transplantation

We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n= 147) and after (n= 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.     

Relative Versus Absolute Carbohydrate-Deficient Transferrin as a Marker of Alcohol Consumption in Patients With Acute Alcoholic Hepatitis

BACKGROUND: Carbohydrate-deficient transferrin has been described as a sensitive and specific marker for alcohol consumption. This study investigated the usefulness of carbohydrate-deficient transferrin as a marker of alcohol consumption in acute alcoholic hepatitis. METHODS: Absolute concentrations (U/I) and relative values (%) of carbohydrate-deficient transferrin determined in serum with commercial assays, as well as conventional markers for alcohol consumption, were compared with the alcohol consumption (as estimated by a questionnaire) in patients with acute alcoholic hepatitis (n = 19), alcoholic liver cirrhosis (n = 37), and nonalcoholic liver diseases (n = 16). RESULTS: The concentration of carbohydrate-deficient transferrin was increased (p < 0.001) in nonabstaining patients (median intake 80 g alcohol/day) with alcoholic liver cirrhosis (45.7 +/- 30 U/l), but not in patients with acute alcoholic hepatitis (20.0 +/- 7.8 U/l) despite higher alcohol consumption (median 130 g/d), nor in abstainers with alcoholic liver cirrhosis (19.4 +/- 6.0 U/l) or nonalcoholic liver disease (18.5 +/- 6.7 U/l). However, the relative values of carbohydrate-deficient transferrin were increased both in acute alcoholic hepatitis (7.9 +/- 2.1%) and nonabstainers with alcoholic liver cirrhosis (7.4 +/- 2.8%), but not in abstainers with alcoholic liver cirrhosis (4.6 +/- 3.5%) or nonalcoholic liver disease (3.8 +/- 0.9%) (p < 0.001). In acute alcoholic hepatitis, the sensitivity and specificity were only 32% and 87% for absolute concentrations, respectively, but 79% and 97% for relative values of carbohydrate-deficient transferrin. The concentrations of carbohydrate-deficient and total transferrin in serum were strongly correlated (r = 0.60; p = 0.008). CONCLUSIONS: The relative value (% of total), but not the absolute concentration, of carbohydrate-deficient transferrin in serum is a useful marker of alcohol consumption in acute alcoholic hepatitis.     

Utility of Biological Markers during Outpatient Treatment of Alcohol-Dependent Subjects: Carbohydrate-Deficient Transferrin Responds to Moderate Changes in Alcohol Consumption

A group of 25 alcohol-dependent subjects in outpatient treatment were monitored for a period of 4 weeks. They were weekly interviewed for their alcohol consumption and their serum levels of carbohydrate-deficient transferrin (CDT) and γ-glutamyltransferase (GT) were analyzed. The majority of the patients reported an excessive and fairly constant alcohol intake during the observation period. When selecting those patients that reported periods of 1 or 2 weeks with moderate changes in alcohol consumption, corresponding changes in CDT were demonstrated. Thus, of 14 patients reporting an increased alcohol consumption for 2 weeks (mean values increased from 57 to 101 g/day), 11 showed an increase in CDT at the end of the period. The mean CDT value of all 14 increased from 5.5 to 6.7% ( p < 0.05). Slight, but not significant, increases were noted in GT, indicating that CDT is more sensitive than GT in detecting increased alcohol consumption. Furthermore, of 17 patients that reported decreased alcohol consumption for one or several weeks, 14 showed decreased CDT and GT values. The mean values of all 17 were reduced from 5.1% to 4.5% (CDT) and from 126 units/liter to 97 units/liter (GT) ( p < 0.05 for both parameters). The results indicate that CDT responds to moderate changes in alcohol consumption in alcohol-dependent patients and may thus be useful as a corrective tool to self-reports of alcohol consumption during outpatient treatments.     

A Correlational Study of Carbohydrate-Deficient Transferrin Values and Alcohol Consumption among Hispanic College Students

One hundred and forty-eight U.S. college students from a small southwestern university were asked to provide or complete the following: the Michigan Alcoholism Screening Test (MAST), a structured alcohol-use interview, and a 10-ml blood sample to be assayed for carbohydrate-deficient transferrin (CDT) levels and γ-glutamyl-transpeptidase (GGTP) activity. Using the data obtained in the interview, only 2 females and 5 males were identified as heavy drinkers. Conclusions regarding the efficacy of the biochemical markers are therefore limited. It was found that CDT levels were significantly and positively correlated with various measures of alcohol consumption among males. There was no similar association between CDT, or GGTP, and alcohol consumption within the female sample.     

Carbohydrate-Deficient Transferrin and Alcohol Dependency: Variation in Response to Alcohol Intake among Different Groups of Patients

Carbohydrate-deficient transferrin (CDT) and γ-glutamyltransferase (GT) were evaluated as markers of alcohol dependency in two different groups of patients. Sensitivity of CDT was nearly 75% for patients hospitalized for detoxification, but lower than 50% for alcohol-dependent patients admitted to acute surgery. CDT correlated with self-reported alcohol consumption in both groups, and sensitivity increased with higher alcohol intake. Sensitivity of CDT for females in both groups was considerably lower than for males, although their alcohol consumption was not significantly different. Serum activity of GT showed almost identical performance as CDT when evaluated by receiver-operating characteristics curve analysis (ROC-analysis), but sensitivity and specificity of the two markers varied differently with both alcohol consumption and age. Among the surgical patients, the highest sensitivity of CDT was found for the middle-aged patients (36 to 50 years), whereas the highest sensitivity of GT was found for the eldest. A tendency for similar age-related differences were also observed among the patients warded for detoxification, but these differences were not statistically significant. A particular difference between the two groups was noted among the youngest patients (21 to 35 years), with a very low sensitivity of CDT (<20%) for the surgical patients and a high sensitivity (77%) for the detoxification group. This difference was not only caused by differences in the present alcohol consumption, but would also be related to differences in drinking pattern or duration. Two commercial kits analyzing CDT were compared and ROC-analysis indicated identical performance of the two. However, a kit determining CDT as percentage of total transferrin showed a somewhat higher sensitivity among patients with low serum transferrin. We conclude that CDT and GT show variant responses to alcohol consumption in different groups of patients. The level of the two markers are related to sex, age, and alcohol consumption. Furthermore, the performance of both markers depend on the patients' history of alcohol abuse. CDT and GT are statistically independent markers and may therefore supplement each other.     

Carbohydrate-Deficient Transferrin (CDT) in Serum as a Possible Indicator of Heavy Drinking in Young University Students

Carbohydrate-deficient transferrin (CDT) in serum was studied as a possible marker of heavy drinking in a sample of 187 female and 102 male 1st year university students from Finland. CDT was measured by a new radioimmunoassay (Pharmacia CDT RIA). Alcohol consumption was measured on a quantity-frequency scale. For female students CDT was 18.2 +/- 0.45 units/liter (mean +/- SEM) and for male students 13.3 +/- 0.48 units/liter. 9.6% of female students and 7.8% of male students had elevated CDT with a cut-off level of 26 units/liter for females and 20 units/liter for males. The correlation between CDT and reported alcohol consumption was 0.30 (p less than 0.001) for females and 0.25 (p = 0.014) for males. Those reporting a consumption of at least 10 kg of pure ethanol per year were considered as heavy drinkers (3.7% of females and 22.5% of males). In female students the average CDT of heavy drinkers did not differ significantly from that of social drinkers but in teetotalers CDT was significantly (p less than 0.03) lower than in female alcohol users. In male students the average CDT of heavy drinkers was higher than the average of social drinkers (p less than 0.1) and significantly higher than the average of teetotalers (p less than 0.001). In the detection of heavy drinking among male students elevated CDT had a specificity of 96.2% and a sensitivity of 21.7%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Carbohydrate-Deficient Transferrin and Conventional Alcohol Markers as Indicators for Brief Intervention among Heavy Drinkers in Primary Health Care

Brief intervention is a promising treatment for heavy drinking. The present study examined the diagnostic value of carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ glutamyltransferase (GGT) in detecting early-phase heavy drinkers for brief intervention treatment in primary health care. Laboratory data were collected from consecutive 20- to 60-year-old, early-phase heavy drinkers (329 males and 136 females), who were willing to undergo brief intervention treatment in five primary health care outpatient clinics. An elevated value of at least 1 of the 5 markers studied was found in 75% of the male and in 76% of the female heavy drinkers. The sensitivities of CDT, MCV, AST, ALT and GGT values were low; in men, respectively, 39%, 28%, 12%, 28%, and 33%. and in women 29%, 40%, 20%, 29%, and 34%. However, marker combinations, including CDT, reached a good level of sensitivity; the best triple combination (CDT or MCV or GGT) was positive in 69% of the men and 70% of the women. According to logistic regression, the age of the patient had an increasing effect on MCV, ALT and GGT. High body mass index increased all transaminases and decreased CDT and MCV. Smoking increased MCV and decreased AST. Thus, primary health care marker combinations, especially those including CDT, should be considered for the detection of early-phase heavy drinkers for brief intervention treatment.     

Isoelectric Focusing/Western Blotting: A Novel and Practical Method for Quantitation of Carbohydrate-Deficient Transferrin in Alcoholics

Carbohydrate-deficient transferrin (CDT) has been described as the single, most accurate marker of chronic alcohol consumption. Rapid, sensitive, and specific measurement of serum CDT levels can thus provide important clinical information concerning patient diagnosis and treatment. To date, however, methods used for assessing CDT concentrations [e.g., analytical isoelectric focusing combined with immunofixation and micro anion-exchange chromatography followed by radioimmunoassay (RIA)] have not been practical enough for widespread laboratory application. In the present study, we examined the use of a different technique, namely isoelectric focusing (IEF) combined with Western blotting (IEF/WB). Serum proteins (20-40 micrograms) were first focused according to isoelectric points (pI) on high-resolution agarose IEF gels (ampholyte pH range of 5-8) containing nonionic detergent. The focused proteins were transferred electrophoretically to nitrocellulose filters, and then stained immunochemically with antihuman transferrin IgG. IEF/WB completely resolved CDT (focusing at pI 5.7 and 5.9) from other serum transferring isoforms, as assessed with neuraminidase-generated CDT standards. Computerized densitometric scanning of the immunoblots allowed CDT levels to be quantitated directly rather than as a quotient. Serum CDT content determined by IEF/WB was highly correlated (r2 = 0.962; n = 17) with values determined previously by RIA. In a larger subject group, CDT levels (mg/liter) measured by IEF/WB were 139 +/- 54 in recently-drinking alcoholics (n = 58), 81 +/- 8 in abstaining alcoholics (n = 7), and 68 +/- 16 in healthy control subjects (n = 16).(ABSTRACT TRUNCATED AT 250 WORDS)