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.

[1]  A. Rosman,et al.  Utility of carbohydrate-deficient transferrin as a marker of relapse in alcoholic patients. , 1995, Alcoholism, clinical and experimental research.

[2]  M. Salaspuro.  Carbohydrate-deficient transferrin as compared to other markers of alcoholism: a systematic review. , 1999, Alcohol.

[3]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[4]  R. Anton,et al.  Comparison of Bio-Rad %CDT TIA and CDTect as laboratory markers of heavy alcohol use and their relationships with gamma-glutamyltransferase. , 2001, Clinical chemistry.

[5]  S. Borg,et al.  A modified method for the assay of carbohydrate-deficient transferrin (CDT) in serum. , 1991, Alcohol and alcoholism (Oxford, Oxfordshire). Supplement.

[6]  C. Alling,et al.  Carbohydrate-deficient transferrin measured by high-performance liquid chromatography and CDTect immunoassay. , 1996, Alcohol and alcoholism.

[7]  E. Haug,et al.  Carbohydrate-deficient transferrin and other markers of high alcohol consumption: a study of 502 patients admitted consecutively to a medical department. , 1994, Alcoholism, clinical and experimental research.

[8]  A. Alterman,et al.  Naltrexone in the treatment of alcohol dependence. , 1992, Archives of general psychiatry.

[9]  A. Rosman,et al.  Measurement of carbohydrate-deficient transferrin by isoelectric focusing/western blotting and by micro anion-exchange chromatography/radioimmunoassay: comparison of diagnostic accuracy. , 1992, Alcohol and alcoholism.

[10]  R. Anton,et al.  Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. , 1999, The American journal of psychiatry.

[11]  D. Simpson,et al.  Carbohydrate deficient transferrin in detecting relapse in alcohol dependence. , 1997, Drug and alcohol dependence.

[12]  R. Anton,et al.  Carbohydrate-deficient transferrin and gamma-glutamyltransferase as markers of heavy alcohol consumption: gender differences. , 1994, Alcoholism, clinical and experimental research.

[13]  John P. Allen,et al.  Measuring Alcohol Consumption: Psychosocial and Biochemical Methods , 1992 .

[14]  John P. Allen,et al.  Measuring Alcohol Consumption , 1992, Humana Press.

[15]  B. Rounsaville,et al.  Naltrexone and coping skills therapy for alcohol dependence. A controlled study. , 1992, Archives of general psychiatry.

[16]  G. Meerkerk,et al.  The specificity of the CDT assay in general practice: the influence of common chronic diseases and medication on the serum CDT concentration. , 1998, Alcoholism, clinical and experimental research.

[17]  A. Helander.  Absolute or relative measurement of carbohydrate-deficient transferrin in serum? Experiences with three immunological assays. , 1999, Clinical chemistry.

[18]  E. Haug,et al.  Serum carbohydrate-deficient transferrin as a marker of alcohol consumption in patients with chronic liver diseases. , 1993, Alcoholism, clinical and experimental research.

[19]  P Bean,et al.  Two methods for measuring carbohydrate-deficient transferrin in inpatient alcoholics and healthy controls compared. , 1994, Clinical chemistry.

[20]  M. Dew,et al.  Carbohydrate deficient transferrin in abstaining patients with end-stage liver disease. , 2001, Alcoholism, clinical and experimental research.

[21]  R. Anton,et al.  Carbohydrate-deficient transferrin levels in a female population. , 1995, Alcoholism, clinical and experimental research.

[22]  P. Sillanaukee,et al.  Carbohydrate-deficient transferrin and conventional alcohol markers as indicators for brief intervention among heavy drinkers in primary health care. , 1998, Alcoholism, clinical and experimental research.

[23]  G. van Melle,et al.  Screening for excessive alcohol drinking. Comparative value of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume. , 1995, Archives of internal medicine.

[24]  C. Spies,et al.  Relevance of carbohydrate-deficient transferrin as a predictor of alcoholism in intensive care patients following trauma. , 1995, The Journal of trauma.

[25]  B. Fagerberg,et al.  Is carbohydrate-deficient transferrin in serum useful for detecting excessive alcohol consumption in hypertensive patients? , 1994, Clinical chemistry.

[26]  M. Salaspuro,et al.  Carbohydrate-deficient transferrin (CDT) in serum as a possible indicator of heavy drinking in young university students. , 1992, Alcoholism, clinical and experimental research.

[27]  P. Sillanaukee,et al.  Comparison of different methods for detecting carbohydrate-deficient transferrin. , 1994, Alcoholism, clinical and experimental research.

[28]  P. Bean,et al.  A new approach to quantitate carbohydrate-deficient transferrin isoforms in alcohol abusers: partial iron saturation in isoelectric focusing/immunoblotting and laser densitometry. , 1993, Alcoholism, clinical and experimental research.

[29]  A. Rosman,et al.  Isoelectric focusing/western blotting: a novel and practical method for quantitation of carbohydrate-deficient transferrin in alcoholics. , 1991, Alcoholism, clinical and experimental research.

[30]  R. Anton,et al.  Carbohydrate-deficient transferrin as an indicator of drinking status during a treatment outcome study. , 1996, Alcoholism, clinical and experimental research.

[31]  T. Koivula,et al.  Blood tests for detection of alcoholic cause of acute pancreatitis , 1994, The Lancet.

[32]  R. Anton,et al.  Carbohydrate-deficient transferrin as a measure of immoderate drinking: remaining issues. , 1994, Alcoholism, clinical and experimental research.

[33]  R. Stauber,et al.  Carbohydrate-deficient transferrin in healthy women: relation to estrogens and iron status. , 1996, Alcoholism, clinical and experimental research.

[34]  H. Gjerde,et al.  A comparison of serum carbohydrate-deficient transferrin with other biological markers of excessive drinking. , 1988, Scandinavian journal of clinical and laboratory investigation.

[35]  R. Anton,et al.  Contribution of carbohydrate deficient transferrin to gamma glutamyl transpeptidase in evaluating progress of patients in treatment for alcoholism. , 1999, Alcoholism, clinical and experimental research.

[36]  K. Lee,et al.  Validity of self-report in alcoholism research: results of a Veterans Administration Cooperative Study. , 1988, Alcoholism, clinical and experimental research.

[37]  S. Borg,et al.  Micro anion exchange chromatography of carbohydrate-deficient transferrin in serum in relation to alcohol consumption (Swedish Patent 8400587-5). , 1986, Alcoholism, clinical and experimental research.

[38]  S. Borg,et al.  Longitudinal comparison of carbohydrate-deficient transferrin and gamma-glutamyl transferase: complementary markers of excessive alcohol consumption. , 1996, Alcohol and alcoholism.

[39]  L C Sobell,et al.  Reliability of a timeline method: assessing normal drinkers' reports of recent drinking and a comparative evaluation across several populations. , 1988, British journal of addiction.

[40]  F. D. Del Boca,et al.  Talk is cheap: measuring drinking outcomes in clinical trials. , 2000, Journal of studies on alcohol.

[41]  C. Müller,et al.  Carbohydrate-deficient transferrin for identification of drug overdose patients at risk of an alcohol withdrawal syndrome. , 1996, Journal of toxicology. Clinical toxicology.

[42]  J. Allen,et al.  Gamma-glutamyltranspeptidase and carbohydrate deficient transferrin: alternative measures of excessive alcohol consumption. , 1995, Alcoholism, clinical and experimental research.

[43]  T. Arndt,et al.  Increased serum concentration of carbohydrate-deficient transferrin in patients with combined pancreas and kidney transplantation. , 1997, Clinical chemistry.

[44]  J. Boeynaems,et al.  A Simple Method for Carbohydrate-Deficient Transferrin Measurement in Patients with Alcohol Abuse and Hepato-Gastrointestinal Diseases , 1998, Annals of clinical biochemistry.

[45]  J. Bisson,et al.  A comparison of carbohydrate deficient transferrin with other markers of alcohol misuse in male soldiers under the age of thirty. , 1994, Alcohol and alcoholism.

[46]  F. Musshoff,et al.  Determination of biological markers for alcohol abuse. , 1998, Journal of chromatography. B, Biomedical sciences and applications.

[47]  M. Tavassoli,et al.  Laboratory markers of ethanol intake and abuse: a critical appraisal. , 1992, The American journal of the medical sciences.

[48]  R. Anton,et al.  The use of carbohydrate deficient transferrin as an indicator of alcohol consumption during treatment and follow-up. , 1996, Alcoholism, clinical and experimental research.

[49]  S. Borg,et al.  Detection of relapses in alcohol-dependent patients using carbohydrate-deficient transferrin: improvement with individualized reference levels during long-term monitoring. , 1995, Alcoholism, clinical and experimental research.

[50]  M. Sterneck,et al.  Carbohydrate-deficient transferrin: diagnostic efficiency among patients with end-stage liver disease before and after liver transplantation. , 1998, Alcoholism, clinical and experimental research.

[51]  P. Dufeu,et al.  Superiority of carbohydrate-deficient transferrin to gamma-glutamyltransferase in detecting relapse in alcoholism. , 1997, The American journal of psychiatry.

[52]  C. Allgulander,et al.  Abnormal microheterogeneity of transferrin in serum and cerebrospinal fluid in alcoholism. , 2009, Acta medica Scandinavica.

[53]  P. Sillanaukee.  Laboratory markers of alcohol abuse. , 1996, Alcohol and alcoholism.

[54]  R. Anton,et al.  The effect of drinking intensity and frequency on serum carbohydrate-deficient transferrin and gamma-glutamyl transferase levels in outpatient alcoholics. , 1998, Alcoholism, clinical and experimental research.

[55]  D. Oslin,et al.  Clinical correlations with carbohydrate-deficient transferrin levels in women with alcoholism. , 1998, Alcoholism, clinical and experimental research.

[56]  C. Lieber,et al.  Changes in carbohydrate-deficient transferrin levels after alcohol withdrawal. , 1988, Alcoholism, clinical and experimental research.

[57]  M. Grønbaek,et al.  Carbohydrate-deficient transferrin--a valid marker of alcoholism in population studies? Results from the Copenhagen City Heart Study. , 1995, Alcoholism, clinical and experimental research.

[58]  H A Skinner,et al.  Alcohol dependence syndrome: measurement and validation. , 1982, Journal of abnormal psychology.