Reliability of Carbohydrate-Deficient Transferrin to Detect Chronic Alcohol Misuse in Carcinoma Patients

Abstract

The patients’ history and conventional laboratory markers are often not sensitive or specific enough to detect chronic alcohol misuse, preoperatively. We investigated whether carbohydrate-deficient transferrin (CDT), determined with a new commercially available kit, is a more sensitive and specific marker to detect chronic alcohol misuse in these patients and we compared it to a CDT research kit and to other conventional laboratory markers. 153 patients with oral, pharyngeal, laryngeal or esophageal carcinomas were evaluated regarding their drinking habits. Chronic alcohol misuse was diagnosed if the daily ethanol intake was ≧60 g and the patient met the DSM-III-R criteria for chronic alcohol abuse or dependence. CDTs and the conventional laboratory markers were sampled on admission of the patients, preoperatively, postoperatively following admission to the ICU and on day 2, 4 and 7 in the ICU. CDT was determined by microanion exchange chromatography and turbidimetry (research kit) and microanion exchange chromatography and radioimmunoassay (commercially available CDT kit), respectively. The investigators were blinded to the CDT results. For all patients admitted to the hospital the sensitivity of the CDT research kit was 74% and for the commercially available CDT kit 77%. Specificity was 100% for the CDT research kit and 97% for the commercially available CDT kit. Both CDT kits were more accurate in detecting chronic alcohol misuse than any other conventional laboratory marker over a range of cutoffs evaluated by receiver operating characteristic curves. Since the CDT values on admission were significantly correlated with the length of ICU stay (CDT research kit: rs = 0.56; p = 0.000; commercially available CDT: rs = 0.39; p = 0.009) and since investigated chronic alcoholics developed more complications in the ICU and had a prolonged ICU stay, it seems reasonable to determine serum CDT, the most sensitive and specific marker of chronic alcohol misuse. Patients with pathologically elevated CDT values should be further evaluated and managed accordingly.

Preoperative Evaluation of Chronic Alcoholics Assessed for Surgery of the Upper Digestive Tract

“…Therefore, in the last years, new diagnostic methods have been established. Carbohydratedeficient transferrin (CDT) has been shown to be more accurate in detecting chronic alcohol misuse in the preoperative period than any other conventional marker (Spies et al, 1996c), and its use has been suggested in combination with other markers to detect alcohol misuse in the preoperative setting (Spies and Rommelspacher, 1999). The CAGE questionnaire (Ewing, 1984) is a four-question screening test that is easy to use in clinical routine and performs well in recognizing severe drinking disorders (Fiellin et al, 2000).…”

Emerging Biomarkers: New Directions and Clinical Applications

“…In patients with upper digestive tract cancer, the prevalence of severe AUDs was high, patients were usually older (mid-50s), and patients usually drank in a more continuous manner (Spies et al, 1995(Spies et al, , 1996a. In these patients, reported sensitivities of CDT were 74 -84%, and specificities were 84 -97% (Neumann and Spies, 2003;Spies et al, 1996aSpies et al, , 1998. Early sampling after admission of CDT had a better sensitivity (74%) compared with sampling preoperatively (39%).…”

“…In unselected hospital populations, the sensitivity (0 -100%) and specificity (81-98%) of CDT, the sensitivity (41-73%) and specificity (63-85%) of GGT, and the sensitivity (27-54%) and specificity (85-91%) of MCV vary widely (Neumann and Spies, 2003). In patients with upper digestive tract cancer, the prevalence of severe AUDs was high, patients were usually older (mid-50s), and patients usually drank in a more continuous manner (Spies et al, 1995(Spies et al, , 1996a. In these patients, reported sensitivities of CDT were 74 -84%, and specificities were 84 -97% (Neumann and Spies, 2003;Spies et al, 1996aSpies et al, , 1998.…”

Perioperative Morbidity and Mortality in Chronic Alcoholic Patients

“…The advantage of this approach using CAGE and the laboratory markers is that CAGE detects alcohol-dependent patients and the markers detect high alcohol consumption. As laboratory markers, carbohydrate-deficient transferrin (CDT), ␥-glutamyltransferase, and mean corpuscular volume should be used (Sillanaukee, 1996;Spies et al, 1995bSpies et al, , 1996dStibler, 1991). Although patient history is essential, there are emergency situations where only laboratory markers are available.…”

“…In traumatized patients, elevated CDT levels identified patients at risk of developing postoperative complications . In this setting, it is reasonable to draw blood in the emergency room as soon as possible, because blood loss and volume replacement may contribute to a more rapid decrease in CDT (Spies et al, 1995b(Spies et al, , 1996d.…”