Relevance of Carbohydrate-Deficient Transferrin as a Predictor of Alcoholism in Intensive Care Patients following Trauma

Abstract

Every second traumatized patient is a chronic alcoholic. Chronic alcoholics are at risk due to an increased morbidity and mortality. Reliable and precise diagnostic methods for detecting alcoholism are mandatory to prevent posttraumatic complications by adequate prophylaxis. The patient's history, however, is often not reliable, and conventional laboratory markers are not sensitive or specific enough. The aim of this study was to investigate whether carbohydrate-deficient transferrin (CDT) is a sensitive and specific marker to detect alcoholism in traumatized patients. One hundred and five male traumatized patients or their relatives gave their written informed consent to participate in this institutionally approved study. All patients were transferred to the intensive care unit after admission to the emergency room, followed by surgical treatment. Diagnostics included an alcoholism-related questionnaire, conventional laboratory markers (mean corpuscular volume, gamma-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase), and CDT sampling (microanion-exchange chromatography, turbidimetry, and radioimmunoassay, respectively). Only patients in whom a reliable history could be obtained were included. Alcoholism was diagnosed if the patients met the Diagnostic and Statistical Manual of Mental Disorders criteria for chronic alcohol abuse or dependence. The administration of fluids before CDT sampling was carefully documented. Patients did not differ significantly regarding age, Trauma and Injury Severity Score, and Acute Physiology and Chronic Health Evaluation score. The sensitivity of the CDT research kit was 70% and of the commercially available kit CDTect was 65%. Early sampling in the emergency room and before administration of large volumes of fluid increased the sensitivity to 83% for the CDT research kit and 74% for CDTect, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydrate‐Deficient Transferrin and γ‐Glutamyltransferase for the Detection and Monitoring of Alcohol Use: Results From a Multisite Study

“…Emphasis still must be placed on clinical interviews, family reports, physical and historical medical findings, other lab tests, and questionnaires (Litten and Allen, 1992). Nevertheless, in busy clinical and emergency settings and where subject report is difficult (such as in trauma, burn, and critical care units), the use of biological markers can provide valuable information on which to base clinical judgment (Jaakkola et al, 1994;Meerkerk et al, 1998;Spies et al, 1995;Yersin et al, 1995). In primary care practice and in specialized treatment settings, the identification of heavy alcohol use and relapse drinking remains a challenge.…”

“…Although initial methods to measure CDT were cumbersome and costly (Bean and Peter, 1993;Stibler et al, 1986;Xin et al, 1991), the advent of test kits (Anton and Bean, 1994;Anton et al, 2001;Helander, 1999;Sillanaukee et al, 1994;Simonsson et al, 1996;Stibler et al, 1991) to evaluate CDT levels allowed for more widespread use and investigation. Reports of the utility of CDT in various clinical populations generally have found it to be specific for alcohol use with its sensitivity varying with the setting in which it was used (Arndt et al, 1997;Bell et al, 1994;Fagerberg et al, 1994;Jaakkola et al, 1994;Koppel et al, 1996;Meerkerk et al, 1998;Sillanaukee et al, 1998;Spies et al, 1995). Whereas CDT appears to be more specific to alcohol use in patients with moderate liver disease (Bell et al, 1993;Cotton et al, 1998;Xin et al, 1992), it is now becoming clear that individuals with the most severe form of liver diseases may have elevated CDT levels despite little or no use of alcohol (DiMartini et al, 2001;Heinemann et al, 1998).…”

Kohlenhydratdefizientes Transferrin (CDT) als präoperativer Alkoholmarker bei chirurgischen Risikopatienten

“…Als potentieller Alkoholmarker wurde CDT u È berwiegend bei forensischen und internistischen Fragestellungen eingesetzt, jedoch nur in wenigen Studien bei chirurgischen Risikopatienten untersucht [1,6,19,20]. Nach regelma È ûiger exzessiver Alkoholingestion kommt es zur Synthesesto È rung des Transferrins und zur Bildung von Isotransferrinen mit fehlenden bzw.…”

Alcohol Biomarker Screening in Medical and Surgical Settings

“…In patients with multiple, severe trauma, CDT shows a sensitivity of 65% in detecting alcohol dependence or abuse. Early sampling in the emergency room and before administration of large volumes of fluids or blood in the initial care increased the sensitivity to 74% for CDT (Spies, 1995). CDT was superior to GGT and MCV (sensitivities o36%) in detecting alcohol dependence or abuse.…”

“…Patients with upper-digestive tract cancer are usually older (in the mid-50s), and these patients usually drink in a more continuous pattern (Spies et al, 1995(Spies et al, , 1996a. Sensitivities of CDT with these patients have been reported to be 74% to 84%, with specificities of 84% to 97% (Neumann and Spies, 2003;Spies et al, 1996Spies et al, , 1998.…”