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

Fagan, Kevin J.; Irvine, Katharine M.; McWhinney, Brett; Fletcher, Linda M.; Horsfall, Leigh; Johnson, Lambro A.; Clouston, Andrew D.; Jonsson, Julie R.; O’Rourke, Peter; Martin, Jennifer; Pretorius, Carel J.; Ungerer, Jacobus P.J.; Powell, Elizabeth E.

doi:10.1111/acer.12143

Cited by 12 publications

(12 citation statements)

References 31 publications

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“…Our results conflict with those in a recent report, where di-tri bridging was not found in a sample of 254 liver disease patients, 48 of whom had biopsy-confirmed cirrhosis (Fagan et al, 2013). These authors speculated that di-tri bridging might only occur in patients with decompensated cirrhosis, but among cirrhotic subjects we did not find a strong link to cirrhosis severity as estimated by MELD and CTP scores.…”

Section: Discussioncontrasting

confidence: 99%

Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease

Stewart

Reuben

Anton

2016

Alcohol and Alcoholism

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Aims: Serum carbohydrate-deficient transferrin (CDT) is a validated test for chronic heavy alcohol drinking, but CDT abnormalities have been associated with liver disease, limiting its use in these patients. We report here on the association between poor chromatographic resolution of disialotransferrin from trisialotransferrin (the so-called 'di-tri bridging') and liver disease severity and etiology. Methods: Subjects were patients in whom detailed clinical data, including histology results, were available on their existing liver diseases (n=139). Percent disialo-CDT (%dCDT) was measured by high-performance liquid chromatography, and the risks for di-tri bridging associated with cirrhosis, with and without adjustment for alcohol use and alcohol-related liver disease, were estimated. Results: Di-tri bridging was present in 22/73 (30%) cirrhotic subjects and 7/66 (11%) non-cirrhotic subjects. The unadjusted risk for di-tri bridging in cirrhotics relative to non-cirrhotics was 3.6 (95% confidence interval 1.4-9.2). Adjustment for alcohol-related liver disease and current drinking had little effect on this estimate (adjusted odds ratio 3.4), and neither alcohol-related liver disease nor current drinking were independently associated with di-tri bridging after accounting for the effect of cirrhosis. Conclusions: The presence of di-tri bridging was associated with cirrhosis in individuals with both alcohol-related and non-alcoholic liver disease, although most cirrhotic subjects did not exhibit di-tri bridging. When di-tri bridging is seen in individuals being tested for chronic heavy drinking, investigation for cirrhosis should be considered. Short summary: There are known liver-disease-associated abnormalities in CDT. In this study, we found that such abnormalities were strongly associated with cirrhosis rather than less-advanced disease, but were only clinically evident in 30% of cirrhotics. Abnormalities also occurred in severe hepatitis without cirrhosis and were not specific for liver disease etiology.

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Section: Discussioncontrasting

confidence: 99%

Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease

Stewart

Reuben

Anton

2016

Alcohol and Alcoholism

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“…We previously investigated the diagnostic utility of %CDT in patients with liver disease, and found that heavy drinkers with a BMI in the overweight or obese range had significantly lower %CDT values than lean heavy drinkers [14]. The current study extends these findings by confirming the results in a larger group of subjects with confirmed heavy alcohol consumption and by showing that the effect of BMI is independent of other clinical variables.…”

Section: Discussionsupporting

confidence: 84%

“…CDT analysis was performed on a Waters HPLC System (Waters Corporation Milford MA USA) as previously described [14]. The currently accepted laboratory reference value indicative of heavy drinking is %CDT > 1.7 [3].…”

Section: Methodsmentioning

confidence: 99%

“…These characteristics include gender and metabolic risk factors such as obesity, insulin resistance, hypertension and dyslipidemia. We recently examined the diagnostic utility of %CDT in a hepatology outpatient setting [14]. Although few patients reported heavy alcohol consumption at the time of study, those acknowledged heavy drinkers with a body mass index (BMI) in the overweight or obese range had significantly lower %CDT values than lean heavy drinkers [14].…”

Section: Introductionmentioning

confidence: 99%

“…We recently examined the diagnostic utility of %CDT in a hepatology outpatient setting [14]. Although few patients reported heavy alcohol consumption at the time of study, those acknowledged heavy drinkers with a body mass index (BMI) in the overweight or obese range had significantly lower %CDT values than lean heavy drinkers [14]. Neither the presence of compensated chronic liver disease, nor the etiology of non-alcoholic liver disease influenced interpretation of the CDT results.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers

et al. 2014

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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.

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Carbohydrate-deficient transferrin is a sensitive marker of alcohol consumption in fatty liver disease

et al. 2022

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BackgroundThe prevalence of nonalcoholic fatty liver disease (NAFLD) and alcohol-associated/related liver disease (ALD) with metabolic syndrome is globally increasing. Metabolic syndrome and excessive alcohol consumption synergically exacerbate liver pathologies; therefore, drinking-speci c serum markers unaffected by liver injury or metabolic syndrome are essential to assess alcohol consumption. We evaluated the ratio of carbohydrate-de cient transferrin to total transferrin (%CDT) in patients with fatty liver disease, particularly focusing on its correlation with metabolic factors (UMIN000033550). MethodsA total of 120 patients with fatty liver disease, including ALD and NAFLD, were screened for alcohol misuse using the Alcohol Use Disorders Identi cation Test. Associations of metabolic syndrome-related factors and hepatic steatosis/liver stiffness with drinking markers such as %CDT, gamma-glutamyl transferase (GGT), and mean corpuscular volume (MCV) were assessed using multiple linear regression analyses. Results%CDT signi cantly increased with 3-4 drinks/day. The optimal cut-off value for identifying non-to light drinkers was 1.78% (sensitivity, 71.8%; speci city, 83.7%; area under the receiver operating characteristic curve [AUROC], 0.851), which was signi cantly higher than that for GGT. The cut-off value for identifying heavy drinkers was 2.08% (sensitivity, 65.5%; speci city, 86.8%; AUROC, 0.815). Multiple regression analysis revealed that this proportion was negatively correlated with body mass index, whereas GGT and MCV were in uenced by multiple factors involved in liver injury and dyslipidemia. Conclusions%CDT showed a strong correlation with alcohol consumption, independent of liver damage, steatosis/stiffness, or metabolic syndrome-related factors, indicating that it is a useful drinking marker for the accurate diagnosis of NAFLD and ALD.

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

Cited by 12 publications

References 31 publications

Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease

Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease

Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers

Carbohydrate-deficient transferrin is a sensitive marker of alcohol consumption in fatty liver disease

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