Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers

Abstract

Background and AimCarbohydrate deficient transferrin (CDT) is the most specific serum biomarker of heavy alcohol consumption, defined as ≥ 350–420 g alcohol/week. Despite introduction of a standardized reference measurement technique, widespread use of CDT remains limited due to low sensitivity. The aim of this study was to determine the factors that affect diagnostic sensitivity in patients with sustained heavy alcohol intake.MethodsPatients with a self-reported history of sustained heavy alcohol consumption were recruited from the hepatology outpatient department or medical wards. Each patient was interviewed with a validated structured questionnaire of alcohol consumption and CDT analysis using the standardized reference measurement technique with high performance liquid chromatography was performed on serum collected at time of interview.Results52 patients were recruited: 19 from the hepatology outpatient department and 33 from general medical wards. Median alcohol intake was 1013 (range 366–5880) g/week over the preceding two week period. 26 patients had a diagnostic CDT based on a threshold value of %CDT > 1.7 indicating heavy alcohol consumption, yielding a sensitivity of 50%. Overweight/obesity (defined as body mass index (BMI) ≥ 25 kg/m2 in Caucasians and ≥ 23.0 kg/m2 in Asians), female gender and presence of cirrhosis were independently associated with non-diagnostic %CDT (≤ 1.7).ConclusionsCDT has limited sensitivity as a biomarker of heavy alcohol consumption. Caution should be applied when ordering and interpreting %CDT results, particularly in women, patients with cirrhosis and those with an elevated BMI.

Phosphatidylethanol is Superior to Carbohydrate‐Deficient Transferrin and γ‐Glutamyltransferase as an Alcohol Marker and is a Reliable Estimate of Alcohol Consumption Level

“…Similar findings have been reported previously. Although misclassification has been suggested, no definite cause to the gender difference has been identified (Bergström and Helander, ; Bertholet et al., ; Bortolotti et al., ; Fagan et al., ). PEth, on the other hand, showed a slightly higher dose–response in women than in men, that is, for the same amount of alcohol consumed women show a somewhat higher PEth value than men.…”

Treatment of Alcohol Use Disorder in Patients with Alcoholic Liver Disease

“…However, for a single drinking episode, the window of detection depends on the quantity of alcohol consumed. (12, 13) Carbohydrate-deficient transferrin (CDT) is a desialylated isoform of transferrin, increases with chronic heavy alcohol intake and is the most specific marker of alcohol use(14); however its sensitivity is limited, particularly in women, end-stage liver disease and overweight/obese individuals(15). Increased serum liver enzymes, alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl transferase (GGT), are markers of inflammation and oxidative stress, and have low specificity for detecting alcohol use.…”

Assays of Gamma‐Glutamyl Transferase and Carbohydrate‐Deficient Transferrin Combination from Maternal Serum Improve the Detection of Prenatal Alcohol Exposure

“…Gamma‐glutamyl transferase (GGT), a widely used traditional biochemical test, has been shown to lack specificity (Halmesmäki et al., ; Joya et al., ). On the other hand, carbohydrate‐deficient transferrin (CDT), which has yielded high specificities in men drinking heavily, has been less accurate in the assessment of pregnant women (Bakhireva et al., ; Fagan et al., ; Joya et al., ; Kenan et al., ; Scouller et al., ; Stoler et al., ). Although a mathematically formulated equation of GGT and CDT (GGT–CDT) has previously been shown to improve the sensitivity of detecting problem drinking in alcoholics admitted for detoxification (Hietala et al., ; Niemelä, ), the diagnostic potential of this marker for correctly classifying alcohol use in pregnant women has remained unknown.…”