Carbohydrate-deficient transferrin (CDT) and HDL cholesterol (HDL) are highly correlated in male alcohol dependent patients

BACKGROUND: Serum levels of total HDL cholesterol (HDL) are reportedly influenced by recent alcohol intake. We examined the correlation between HDL cholesterol and widely used markers of excessive alcohol intake, such as carbohydrate-deficient transferrin (CDT), gamma-glutamyl-transferase (GGT), or mean corpuscular volume of erythrocytes (MCV), of which CDT is thought to be the most specific. METHODS: Several serological markers [i.e., CDT, GGT, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), MCV, and HDL] were determined in 100 actively drinking male patients with alcohol dependence (DSM-IV) and in 27 non-alcohol-dependent controls, according to routine procedures. Spearman's rank correlation coefficients were calculated. RESULTS: We found a highly significant positive correlation between HDL and CDT (r(s) = 0.55; p < 0.0005) in patients, but not in controls (r(s) = 0.13;p = 0.51). HDL was also positively correlated with GGT, ALAT, ASAT, and MCV only in patients. CONCLUSIONS: HDL cholesterol, as a widely determined parameter, may represent a useful routine marker for recent excessive alcohol intake. High HDL cholesterol levels should alert clinicians to investigate a patient's recent pattern of alcohol consumption.     

Sex differences of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume in alcohol-dependent patients

BACKGROUND: Biological markers like carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV) are used widely to screen for alcoholism. Most research has focused on male alcoholics, and there are few studies on female patients. The results are inconsistent; in general, they show lower sensitivities for all markers for women. METHODS: We compared the diagnostic value of CDT, GGT, and MCV in 126 alcohol-dependent patients (91 men, 35 women) who entered an inpatient treatment program. For the receiver operating characteristic (ROC) analyses, we investigated a control group of 112 patients (64 men, 38 women) from the Department of Psychiatry at the University of Tübingen with no diagnosis of substance abuse or substance dependency. RESULTS: Mean levels of CDT and MCV were significantly different in male and female patients. CDT showed higher test results in men (4.4% vs. 2.8%, p < 0.05), whereas mean levels of MCV were higher in women (99.7 fl vs. 96.4 fl,p < 0.01). The sensitivities of CDT and GGT were higher in men than in women (CDT: 76% vs. 54%,p < 0.1; GGT: 68% vs. 43%,p < 0.05), and the sensitivity of MCV was significantly higher in women (71% vs. 41%,p < 0.01). The superiority of MCV in women also was supported by ROC analyses (p < 0.01). The combined use of markers showed satisfactory sensitivity rates of > or = 80% not only in men but also in women. Yet, the specificity rates were partly below the recommended 90% for identifying alcohol abuse; therefore, these markers must be combined with caution. CONCLUSIONS: If combined, the biological markers CDT and GGT are useful diagnostic instruments for both alcohol-dependent men and women. According to our results, the "forgotten" marker MCV is superior in women and is a marker of second choice in men. The combination GGT and MCV is the most cost-effective choice for men and women.     

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.     

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.     

Gamma-Glutamyltranspeptidase,Aspartate Aminotransferase,and Erythrocyte Mean Corpuscular Volume as Indicators of Alcohol Consumption in Liver Disease

Gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and erythrocyte mean corpuscular volume (MCV) were used as indicators of continued alcohol abuse in 178 patients with known liver disease studied for 5–49 months after diagnosis. Abstension was checked by interviews and blood alcohol determinations. Persistent alcoholics had significantly higher values for all three tests than abstainers. At values above upper normal limits, GGT was the most sensitive test, but the least specific. A positive predictive value of 80% for continued alcohol consumption was chosen, and the corresponding discriminating levels of the tests were compared. With this specificity GGT was the least sensitive test, and it did not add to the efficiency of ASAT or MCV when the tests were combined. Abstinence could not be predicted by low levels of the tests. It is concluded that these biochemical tests are valuable as indicators of alcohol consumption in patients with liver disease and that ASAT and MCV are equally efficient, whereas GGT is inferior to these.     

Gamma-glutamyltranspeptidase, aspartate aminotransferase, and erythrocyte mean corpuscular volume as indicators of alcohol consumption in liver disease

Gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and erythrocyte mean corpuscular volume (MCV) were used as indicators of continued alcohol abuse in 178 patients with known liver disease studied for 5-49 months after diagnosis. Abstension was checked by interviews and blood alcohol determinations. Persistent alcoholics had significantly higher values for all three tests than abstainers. At values above upper normal limits, GGT was the most sensitive test, but the least specific. A positive predictive value of 80% for continued alcohol consumption was chosen, and the corresponding discriminating levels of the tests were compared. With this specificity GGT was the least sensitive test, and it did not add to the efficiency of ASAT or MCV when the tests were combined. Abstinence could not be predicted by low levels of the tests. It is concluded that these biochemical tests are valuable as indicators of alcohol consumption in patients with liver disease and that ASAT and MCV are equally efficient, whereas GGT is inferior to these.     

Biological markers of alcohol consumption in nondrinkers,drinkers, and alcohol-dependent Brazilian patients

BACKGROUND: The purpose of this study was to compare the sensitivity and specificity of some new and traditional biological markers and indicators of health among Brazilian nondrinkers, drinkers, and alcohol-dependent patients. MATERIAL AND METHODS: We evaluated 130 nondrinkers, 167 drinkers, and 183 alcohol-dependent drinkers from Brazil who participated in the WHO/ISBRA Study on State and Trait Markers of Alcohol Use and Dependence. A standardized WHO/ISBRA Interview Schedule provided background information on the subjects' characteristics including reported health problems and alcohol consumption. Blood samples were analyzed for aspartate aminotransferase (AST), carbohydrate deficient transferrin (CDT), gamma-glutamyltransferase (GGT), blood alcohol levels (BAL), and platelet adenylate cyclase activity (basal levels [AC] and levels after stimulation with Gpp(NH)p, cesium fluoride, and forskolin). RESULTS: The alcohol-dependent drinkers presented higher levels of AST, GGT, AC, CDT, and BAL than the nondrinkers and drinkers, whose levels were similar. Sex differences in the sensitivity of CDT and AC were found. The alcohol-dependent women presented a lower prevalence of abnormal values of CDT and Gpp(NH)p-stimulated AC than the alcohol-dependent men, despite the fact that they presented similar alcohol consumption levels. The alcohol-dependent drinkers presented a higher prevalence of clinical disorders than the nondrinkers and drinkers. The drinkers and alcohol-dependent patients presented significantly higher rates of gastritis than the nondrinkers. CONCLUSIONS: Sex differences in the sensitivity of CDT and AC suggest that these markers are not as sensitive at detecting excessive alcohol use in women as they are in men. If data from this Brazilian sample are compared with those reported for international samples, relevant differences are detected, which suggests that genetic and cultural differences should be considered in the selection of biological markers of heavy alcohol consumption.     

Serum β-Hexosaminidase as a Marker of Heavy Drinking

β-hexosaminidase, also called n -acetyl-β- d -glucosaminidase, is a lysosomal glycosidase, which has been found to be increased in the sera of alcoholics admitted to acute detoxification treatment. To study serum β-hexosaminidase (β-HEX) as a marker of heavy drinking, it was compared with GGT, ASAT, and ALAT in three study groups: twentyfive drunken arrestees, 16 social drinkers, and 27 teetotallers. Mean serum β-HEX levels were two times higher among drunken arrestees than among social drinkers or teetotallers. Average daily alcohol intake during the preceding 30 days in the pooled group of drunken arrestees and social drinkers correlated positively ( r = 0.69; p < 0.0001) with serum β-HEX. The sensitivity of β-HEX in the detection of heavy drinking, defined as over 60 g ethanol daily, was 85.7% compared to 47.6% for GGT. The specificity of β-HEX was 97.6%. The positive correlations between β-HEX and ASAT ( r = 0.74; p < 0.0001) and ALAT ( r = 0.41; p < 0.05) indicate that increased serum β-HEX level may reflect early liver injury. Serum β-HEX seems to be a sensitive biological marker of heavy drinking reflecting better the ingested amounts of alcohol than GGT.     

Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

AIM: To demonstrate if carbohydrates deficient transferrin (CDT) is the best marker to detect an excessive alcohol consumption as a cause of acute pancreatitis. MATERIAL AND METHODS: Prospective study of 60 patients consecutively admitted in our hospital. Acute pancreatitis were classified according to their different etiologies, alcoholic (11), probably alcoholic (4), biliary (25) and others (20). In all cases, we have compared CDT with classical quemical markers of alcohol abuse such as mean corpuscular volumen (MCV), gamma-glutamyltransferase (GGT) and aspartateaminotransferase (AST). Statistic correlations were done between the quantity of alcohol consumed and CDT, GGT, AST and MCV variables. RESULTS: Correlation between CDT and MCV with the excessive alcohol consumption was statistically significant. The acute pancreatitis caused by alcohol and the suspicious alcoholic group had a average CDT higher than the rest of the groups (p < 0.05). Taking a cut point with a CDT value of 20, the diagnosis capacity of the test to detect the alcoholic etiology was 82 and 92% of specificity. Taking a cut point with a MCV value higher than 95, sensibility was 67% and specificity was 82%. CONCLUSION: In our experience, the most efficient marker of the alcoholic etiology in acute pancreatitis was CDT.     

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     

Carbohydrate-deficient transferrin and gamma-glutamyltransferase for the detection and monitoring of alcohol use: results from a multisite study

BACKGROUND: The purpose of this article is to evaluate the biological marker of heavy alcohol use, carbohydrate-deficient transferrin (CDT), in contrast to the older and more widely used gamma-glutamyltransferase (GGT) for the detection and monitoring of heavy alcohol use. METHODS: In this report, CDT and GGT sensitivity and specificity for heavy alcohol intake are examined in a large multisite study in which 444 recently admitted inpatient alcoholics were compared with 204 matched social drinker controls. In addition, changes in these biomarkers were evaluated during an initial abstinence period and biweekly over 14 weeks of monitoring to compare changes in CDT and GGT during continued abstinence or relapse. RESULTS: CDT and GGT were comparable in identifying heavy alcohol consumption in men, but GGT appeared to be better for women. For both genders, when these markers were combined, there was better sensitivity than when used alone. CDT and GGT both decreased during 4 weeks of abstinence. When we used a 30% increase from baseline abstinent levels as an indicator, CDT appeared marginally better than GGT at indicating relapse in men but not in women. For men in particular, relapse over the course of the study was best identified by evaluating changes (30% increase) in both markers simultaneously. CONCLUSIONS: These results support the utility of CDT, especially when used in conjunction with GGT, as an aid in detecting and monitoring heavy alcohol consumption.     

Biological Markers of Alcoholism With Respect to Genotypes of Low-Km Aldehyde Dehydrogenase (ALDH2) in Japanese Subjects

Background: Although the mutant low-Km acetaldehyde dehydrogenase (ALDH2) allele (ALDH2²) with reduced capacity to metabolize acetaldehyde offers biological protection against alcoholism and subsequent alcohol-induced organ damage in many individuals, a significant proportion of individuals with heterozygote of the normal and mutant ALDH2 gene (ALDH2¹/2²) consume excessive amounts of alcohol. Indeed, it has been postulated that habitual drinkers with ALDH2¹/2² may be at a higher risk for alcoholic liver disease than those with ALDH2¹/2¹. In this study, we determined how representative biological markers of alcoholism (γ-glutamyltransferase [GGT], carbohydrate-deficient transferrin [CDT], and the mean corpuscular volume of erythrocytes [MCV]) differ with respect to the ALDH2 genotypes in Japanese habitual drinkers. Methods: We obtained genomic DNA samples from 227 Japanese men with various drinking habits. ALDH2 genotypes were determined by allele-specific polymerase chain reaction. GGT, CDT, and MCV were determined and compared between ALDH2¹/2¹ and ALDH2¹/2² habitual drinkers who consumed more than 66 g of alcohol per day for more than 5 years. We measured CDT by anion-exchange chromatography followed by turbidity immunoassay by using a commercially available assay kit (Axis %CDT TIA). Results: CDT levels were comparable between the two groups. GGT activities were significantly greater in ALDH2¹/2¹ than in ALDH2¹/2² habitual drinkers (81 ± 85 vs. 53 ± 40 IU/liters, p < 0.02). MCV values, on the other hand, were significantly larger in ALDH2¹/2² than in ALDH2¹/2¹ subjects (98.2 ± 5.8 vs. 95.8 ± 4.2 fl, p = 0.02). When we used elevation of either CDT or GGT to detect habitual drinking in ALDH2¹/2¹ and 2¹/2² subjects, the sensitivities were 57% and 46%, respectively. CDT levels were similar between habitual drinkers with normal aspartate aminotransferase levels and those with elevated levels. Conclusion: GGT and MCV, but not CDT, differ with respect to the ALDH2 genotypes in Japanese male habitual drinkers. ALDH2 genotypes should be considered when interpreting data on biological markers of alcoholism.     

Carbohydrate-Deficient Transferrin as a Marker of Alcohol Abuse: Relationship to Alcohol Consumption, Severity of Liver Disease, and Fibrogenesis

Carbohydrate-deficient transferrin (CDT) measurements have been widely examined as a marker of excessive alcohol consumption, yet the information on the sensitivity of this method has remained controversial. In addition, little is known of the relationship of this marker and the severity of alcoholic liver disease (ALD). To clarify these Issues, we analyzed serum samples from 373 alcohol abusers, including 200 problem drinkers with no apparent liver pathology, 173 patients with clinical or morphological evidence of ALD, and 42 healthy controls. CDT was analyzed by anion-exchange chromatography followed by radioimmunoassay. At a specificity of 100%, the sensitivity of CDT was 36% in problem drinkers reporting a mean of 710 ± 80 (mean ± 2SE) g of ethanol/week, as compared with the sensitivities of 44% and 35% for γ-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV), respectively. In a subgroup of problem drinkers (n= 51) with the highest ethanol intakes (1160 ± 180 g of ethanol/week) and severe dependence, the sensitivity of CDT increased to 64%, compared with 55% for GGT and 39% for MCV. In ALD, the CDT values were significantly higher than in the alcoholics with nonliver pathology. However, when such patients were classified according to the clinical, laboratory, and morphological severity of liver disease, CDT was found to be primarily elevated in those with the early stage of ALD, such that there was a significant negative correlation between CDT and the combined morphological index of disease severity (r_s= -0.315, p < 0.05). ALD markers of fibrogenesis were elevated more frequently than CDT, showing significant positive correlations with the indices of disease severity. Current data indicates that, although CDT concentration correlates with the amount of alcohol consumed, it lacks diagnostic sensitivity in alcohol abusers consuming < 100 g of alcohol per day, thus hampering its use as a screen for consumption in community samples. The finding that CDT is increased in an early phase of ALD may prove to be of diagnostic value.     

Association of carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) with serum lipid profile in the Finnish population

BACKGROUND: Moderate consumption of alcohol may reduce mortality from vascular diseases. The beneficial effects of alcohol may partly be mediated by its effects on lipoprotein metabolism. We studied the connection between alcohol consumption and the serum lipid profile from a well-documented national health program study. METHODS AND RESULTS: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. The laboratory analyses were carried out on 5675 subjects (3097 males and 2578 females). The subjects were divided into quartiles on the basis of CDT or GGT value. The highest CDT quartile and the lowest GGT quartile seemed to be associated with a favorable lipid profile and the lowest CDT quartile and the highest GGT quartile were associated with an unfavorable lipid profile. Serum high density lipoprotein (HDL) cholesterol values were significantly higher and triglycerides lower with increasing serum CDT concentrations for both men and women. Increasing serum GGT was associated with higher serum total cholesterol and higher triglycerides in both men and women and lower HDL cholesterol in men. CONCLUSIONS: CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may lead to a better understanding of the effects of alcohol consumption on lipids as well as mechanisms behind favorable and detrimental effects of alcohol on vascular diseases. Condensed abstract: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. A total of 3097 males and 2578 females were divided into quartiles on the basis of their CDT or GGT values. The highest CDT quartiles had higher HDL and lower triglycerides, whereas the highest GGT quartiles appeared to be associated with higher total cholesterol and triglycerides in both genders and lower HDL in men. CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may have important clinical and public health implications.     

Laboratory markers carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume are not useful as screening tools for high-risk drinking in the general population: results from the Study of Health in Pomerania (SHIP)

BACKGROUND: Assessment of high-risk drinking in the general population can be problematic: questionnaire-based instruments may carry the problem of random or systematic recall bias, and the effectiveness of screening of single biomarkers has been shown to be insufficient. In this article, we analyze the alcohol intake/biomarker relationship of carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and erythrocyte mean corpuscular volume (MCV). Specific aims were (1) screening effectiveness comparison of GGT, CDT, and MCV in terms of sensitivity, specificity, and positive (PPVs) and negative predictive values (NPVs) and the effect of covariates on these measures; (2) the comparison of summary measures for the effectiveness of screening: the receiver characteristic curve (ROC) and the area under the ROC; and (3) to answer the question of which covariates effect which biomarkers and whether accounting for relevant covariates increases the prognostic value of biomarkers to levels that allow for application in the general population. METHODS: In a representative cross-sectional health survey in northeast Germany with data collection from 1997 to 2001, 4310 men and women were asked for their recent alcohol consumption and smoking. Biomarkers were analyzed from blood samples. The effectiveness of screening of CDT, GGT, and MCV for high-risk drinking (men: >60 g/day, women: >40 g/day) was analyzed with PPV and ROC curve analysis. RESULTS: For all three biomarkers, PPVs for high-risk drinking are very low (< 50%). There are some effects of covariates on screening effectiveness and on PPV, and knowledge of these covariates increases screening effectiveness, but no subgroup that had a combination of covariate levels and prevalence of high-risk drinking that led to a PPV > 50% could be found. CONCLUSIONS:: Accounting for covariates in the screening procedure does not lead to a sufficient increase in PPV. Screening effectiveness of laboratory markers CDT, GGT, and MCV is insufficient for their application as screening tools for high-risk alcohol drinking in the general population. This was found using self-reported alcohol consumption as an imperfect gold standard, which is a limitation of the study, although self-reports are the standard instrument in comparable epidemiologic studies.     

Effect of hormone balance on carbohydrate-deficient transferrin and gamma-glutamyltransferase in female social drinkers

BACKGROUND: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) are the most commonly used markers for alcohol abuse, but their sensitivity and specificity are lower and have different reference values among females compared with males. In the present study, we evaluated the effect of women's hormone balance on these two alcohol markers, as well as on their mathematical combination, named gamma-CDT. METHODS: An age-stratified random sample of 3962 women, between 25-74 years old, was drawn from the normal population. Pregnancy, the use of oral contraceptives, intrauterine device for contraception, hormone replacement therapy, and hormone treatment for infertility were considered. A comparison between fertile, peri- and postmenopausal women was also done. RESULTS: Existing pregnancy increased CDT levels but decreased GGT values. Lower CDT and higher GGT levels were observed among those women using oral contraceptives and in postmenopausal women compared with women at the fertile stage. gamma-CDT was not influenced by hormone balance. CONCLUSIONS: The different hormonal status had an opposite effect on CDT and GGT. Women who were close to late menopause had levels of both markers closer to the values of men. It must be pointed out that the findings presented here are based on measurements of absolute CDT values and that no measurements of total transferrin were done. gamma-CDT, not influenced by hormone balance, indicates promising clinical utility among women.     

Enhanced clinical utility of gamma-CDT in a general population

BACKGROUND: The use of a combination of markers to detect excessive alcohol consumption has been reported to provide better sensitivity in the diagnosis of alcohol abuse than single markers. However, the optimal combination of markers for the diagnosis of alcohol abuse has not yet been found. The aim of this study was to compare the diagnostic value of carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) to discriminate among heavy drinkers (>280 g/week), moderate drinkers (105-280 g/week), and light drinkers (<105 g/week). Their mathematical combination, named gamma-CDT, which has been found to be a strong marker of alcohol abuse in a former study, was also evaluated. METHODS: The study was conducted in a group of 6962 subjects (3974 males and 2988 females), between the ages of 25 and 74 years, who participated in a large cross-sectional risk factor survey carried out in five geographic areas in Finland. In each study area, an age- and gender-stratified random sample was drawn from the general population. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic curves were used to evaluate the performance of CDT, GGT, and gamma-CDT. RESULTS: For both sexes, the combined marker had the highest specificity (95%) and sensitivity in detecting heavy drinkers. In all cases, gamma-CDT had the highest area under ROC plots. Our results also showed that GGT and CDT have similar, and rather low, sensitivity but high specificity in a general population. CONCLUSIONS: Compared with single markers, a significant improvement of sensitivity was obtained when the combination of both markers was used, especially in females.     

Effect of detoxification on liver stiffness assessed by Fibroscan® in alcoholic patients

Aims: The aims of this study were to determine whether alcohol consumption or cessation influences transient elastography (TE) measurements and whether TE is a useful tool to monitor alcoholic patients. Patients: Twenty‐three consecutive heavy drinkers (20 men and 3 women; mean age 47.2 years) admitted for a 7‐day hospitalization for alcohol detoxification were included. On admission (D0), a detailed medical history was taken and the following laboratory tests were performed [aspartate aminotransferase (ASAT), gamma glutamyltransferase (γGT), and carbohydrate‐deficient transferrin (CDT) levels, and Fibroscan^®]. All examinations were repeated on D8, D30, and D60. Variation in the median Fibroscan value of >20% was considered significant. Results: After 1 week of detoxification, the % variation in TE was ?21.67 ± ?27.6%. The median variation in TE between D8 and D60 was ?20% in the abstinent group and 32% in the relapse group (p = 0.007). An increase in proportion of patients with a significant decrease in TE was observed with an increased duration of abstinence: 41.7% at D8 and 66.7% at D60. TE values were significantly correlated with ASAT, γGT, and CDT at D0 and D8, and with ASAT and γGT at D60. Conclusions: TE in alcoholics is influenced by major variations in the biochemical activity of the disease. The kinetics of variation of TE suggest that this method may be useful to assess alcohol abuse and control.     

The Effect of Drinking Intensity and Frequency on Serum Carbohydrate-Deficient Transferrin and γ- Glutamyl Transferase Levels in Outpatient Alcoholics

Whereas heavy alcohol consumption is known to elevate serum carbohydrate-deficient transferrin (CDT) and γ-glutamyl transferase (GGT) levels, the contribution of drinking pattern to these effects is not completely understood. We present data on 423 men and 146 women evaluated 1 year after treatment in a large-scale alcoholism treatment study (Project MATCH). Relationships between drinking frequency (number of days drinking), intensity (drinks per drinking day), and blood levels of CDT and GGT were analyzed by using response surface regression models and thin-plate spline-smoothing techniques. Both models indicated differences between CDT- and GGT-drinking pattern relationships in men and, also, a difference between men and women in CDT drinking-pattern relationships. For men, CDT levels appeared to respond primarily to frequency of drinking, whereas GGT was influenced primarily by drinking intensity. For women, both CDT and GGT were influenced more by drinks per drinking day (intensity) than by number of days drinking (frequency). The data confirm both the independent nature of these biological markers of alcohol consumption and gender differences in alcohol-induced CDT response reported previously.     

IgA Immune Responses Against Acetaldehyde Adducts and Biomarkers of Alcohol Consumption in Patients with IgA Glomerulonephritis

Background: The pathogenesis of IgA glomerulonephritis (IgAGN) involves intense deposition of IgAs within the glomerulus. Although previous studies have shown that heavy drinking frequently leads to the generation of IgA antibodies against neo‐antigens induced by ethanol metabolites and tissue deposition of IgAs, the associations between alcohol consumption, IgA immune responses, and kidney disease have not been examined. Methods: A total of 158 IgAGN patients (96 men, 62 women) were classified as abstainers (n = 38), moderate drinkers (n = 114), and heavy drinkers (n = 6) based on self‐reported alcohol consumption. The reference population included 143 individuals (99 men, 44 women) who were either apparently healthy abstainers (n = 31), moderate drinkers (n = 43), or heavy drinkers devoid of liver disease (n = 69). The assessments included various biomarkers of alcohol consumption: carbohydrate‐deficient transferrin (CDT), glutamyl transferase, γ‐CDT (combination of GGR and CDT), mean corpuscular volume (MCV), tests for liver and kidney function, serum immunoglobulin A (IgA), and specific IgA antibodies against acetaldehyde–protein adducts. Results: In male IgAGN patients, drinking status was significantly associated with MCV, p < 0.001; CDT, p < 0.01; and γ ‐CDT, p < 0.05. In the reference population, all biomarkers and anti‐adduct IgA levels were found to vary according to drinking status. In IgAGN patients, anti‐adduct IgA levels were elevated in 63% of the cases but the titers did not associate with self‐reported ethanol intake. Conclusions: These data indicate high levels of IgA antibodies against acetaldehyde‐derived antigens in IgAGN patients, which may hamper the use of the immune responses as markers of alcohol consumption among such patients. Future studies on the pathogenic and prognostic significance of anti‐adduct immune responses in IgAGN patients are warranted.