Measuring Carbohydrate-Deficient Transferrin by Direct Immunoassay: Factors Affecting Diagnostic Sensitivity for Excessive Alcohol Intake

Abstract

Background: Carbohydrate-deficient transferrin (CDT) is a marker of alcohol intake that is used for detecting or monitoring alcohol-use disorders. The introduction of a new direct immunoassay for CDT justifies reevaluation of test performance and reexamination of factors affecting test diagnostic sensitivity and specificity. Methods: Individuals enrolled in twin/family studies of alcohol use and dependence provided blood samples and information on recent alcohol use. Serum CDT concentration was measured in 2 088 people with the N Latex CDT (Dade Behring) method, and CDT percentage (CDT%) was calculated as the proportion of the total transferrin concentration measured with Roche reagents. Results: Diagnostic sensitivity was low, both for comparisons of men who reported an alcohol intake of >28 drinks/week vs those who consumed ≤28 drinks/week (28% sensitivity) and for women who consumed >14 drinks/week vs those who consumed ≤14 drinks/week (18% sensitivity), at cutoff values that yielded a 95% specificity. Body mass index, variables associated with metabolic syndrome, and smoking had notable effects on the probability of an abnormal CDT result with excessive alcohol use. Diagnostic sensitivity was greater in men of normal weight (43%) than in obese men (10%) and greater in male smokers (38%) than in male nonsmokers (21%). In women, diagnostic sensitivities were ≤20%, even for those of normal weight and for smokers. Conclusions: CDT is a poor marker of excessive alcohol intake in both women and men who are overweight or obese. It is also less useful in nonsmokers than in smokers. The diagnostic performance of the direct immunoassay and the effects of obesity and smoking are similar to those reported with previous anion-exchange immunoassay methods.

BMI But Not Stage or Etiology of Nonalcoholic Liver Disease Affects the Diagnostic Utility of Carbohydrate‐Deficient Transferrin

“…This is a critical observation that may reduce the diagnostic utility of %CDT. Two previous studies recruited from a large twin registry identified that an "insulin resistant" phenotype (increased BMI and triglyceride levels, low high-density lipoprotein cholesterol) was associated with reduced effect of alcohol intake on the CDT response (Whitfield et al, 1998(Whitfield et al, , 2008. Similarly, a study of hypertensive men with metabolic risk factors demonstrated a positive relationship between serum CDT concentration and glucose disposal rate during hyperinsulinemic-euglycemic clamp (Fagerberg et al, 1994).…”

Evolution of the Surgeon-Volume, Patient Outcome Relationship

“…2 Available biomarkers are of limited use for identifying individuals with alcohol abuse; especially in obese populations. 15 These factors underscore the importance of performing thorough pre-and postoperative assessment, as well as providing adequate follow-up for bariatric surgery patients. Employing a multidisciplinary team is perhaps the best approach.…”

Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers

“…Previous population-based studies measuring CDT by ion-exchange chromatography and immunoassay found several patient characteristics, including gender, a high BMI and an insulin-resistant phenotype (high triglycerides and low HDL-cholesterol) were associated with reduced sensitivity of the CDT response to alcohol [8,10]. In contrast, more recent studies that quantified CDT using the standardized HPLC method did not find any clinically significant differences in CDT in relation to gender or BMI [21].…”

“…Previous studies using older methods of CDT analysis such as immunoassays and anion-exchange methods have identified several patient characteristics that affect diagnostic sensitivity [8-13]. These characteristics include gender and metabolic risk factors such as obesity, insulin resistance, hypertension and dyslipidemia.…”