In certain populations, the biological alcohol marker carbohydrate-deficient transferrin (CDT) is known to have a high diagnostic accuracy. The aim of this study was to compare the diagnostic accuracy of CDT, gamma-glutamyltransferase (gamma-GT), and mean cell volume (MCV) in a general practice population; more specifically, to ascertain whether CDT is a better tool than gamma-GT and MCV for (early) recognition of excessive alcohol use. To represent the general practice situation as realistically as possible, three different drinking patterns are defined: irregular excessive, regular excessive, and very excessive. From a sample of 524 men from seven general practices, sensitivity, specificity, and predictive values of the three markers for the three drinking patterns were compared, and receiver-operating characteristic analysis was used to compare differences between the markers. The results indicate that drinking patterns do influence the (difference in) diagnostic accuracy. CDT has a higher diagnostic accuracy for all three drinking patterns than gamma-GT and higher predictive values for hazardous [(ir)regular excessive] drinking patterns than MCV. However, receiver-operating characteristic analyses failed to demonstrate a significant difference between these patterns. It is concluded that the performance of all tests is too low to be useful for screening procedures in a general population; however, some tests may be useful for case finding. CDT seems to be the best alcohol marker available, although the difference between CDT and MCV is small.
Early recognition of alcohol problems by general practitioners might be enhanced by the use of better alcohol markers. Several studies have revealed promising results for the carbohydrate-deficient transferrin (CDT) assay in certain populations. The aim of our study was to examine the specificity of the CDT assay in a general practice population. The main research question was whether common chronic diseases and/or the accompanying prescribed drugs have a negative influence on the specificity of the CDT assay. The 524 men who participated were selected from seven general practices and were suffering from one or more of the following diseases: hypertension, asthma/bronchitis, diabetes mellitus, adipositis/lipid metabolism disorder, angina pectoris, depression, and disorders of the digestive tract. None of the studied diseases or of the accompanying prescribed drugs had an influence on the specificity of the CDT assay. The overall specificity in this general practitioner population was 0.92. It can be concluded that the studied diseases do not bear an influence on the serum CDT concentration, and that, therefore, the CDT assay is a highly specific instrument for use in assessing alcohol consumption in general practice patients.
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