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.