Carbohydrate-deficient Transferrin Values Research Articles

Carbohydrate‐Deficient Transferrin in Relation to the Menopausal Status of Women

Carbohydrate-deficient transferrin (CDT) has been reported as an excellent marker for male alcohol abuse. Little is known about its validity among women, in whom rather conflicting data concerning the efficiency of the CDT marker and its biochemical mechanism have been reported. Moreover, it is not clear why the reference ranges are different for women (0 to 26 Units per liter) and men (0 to 20 Units per liter). In this population-based study, we examined the normal CDT values measured by CDTect in 331 healthy female teetotalers, randomly selected from a large cohort. They were divided into four groups: premenopausal women (n = 76), perimenopausal women (n = 86), postmenopausal women (n = 84), and users of estrogens/progestagens (n = 85). The mean of the CDT value in the premenopausal group (15.2 Units per liter) was significantly higher than the mean in the postmenopausal group (13.6 Units per liter; p < 0.016). In pre- and perimenopausal women, higher CDT levels were associated with the last period of menstruation; for women menstruating less than 1 month ago versus longer ago, the mean serum CDT value was 15.4 vs. 13.0 Units per liter (p < 0.01). The premenopausal state seems to increase serum levels of CDT, probably due to the amount and frequency of blood loss during the menstrual period, and should be considered when interpreting CDT values in women.

Biological markers as indicators for relapse in alcohol‐dependent patients

Although biological markers such as carbohydrate-deficient transferrin (CDT), γ-glutamyl transferase (GGT) and mean corpuscular volume (MCV) have been used as indicators for heavy alcohol consumption and alcoholism little information is available on the utitlity of these markers in detecting relapses. In this study the value of the biological markers CDT, GGT and MCV was examined in monitoring an outpatient treatment programme for alcohol-dependent patients. In 163 male alcoholic patients CDT, GGT and mean corpuscular volume (MCV) were assayed at the beginning and after 6 months during the outpatient programme. All markers distingushed between relapsers and abstainers (p<0.01). The sensitivity for relapses was 55% for CDT, 50% for GGT and 20% for MCV. Combining all markers the sensitivity could be enhanced to 85%, with only a little loss of specificity (85%). The highest positive predictive value was 73% for CDT used as a single marker. The negative predictive value (CDT 93%, GGT 92%, MCV 88%) and the diagnostic efficiency (CDT 91%, GGT 87%, MCV 85%) of all markers were very high. These results indicate that CDT is the most efficient marker for alcohol relapses, followed by GGT. MCV seems to be a marker of second choice.

CDTect-RIA and CDTect-EIA for determination of serum carbohydrate-deficient transferrin compared.

CDTect-RIA and CDTect-EIA for determination of serum carbohydrate-deficient transferrin (CDT) by radioimmunoassay and enzyme immunoassay respectively were tested for equality and precision in four European laboratories. For correlational studies, serum samples with CDT concentrations up to 130 U/l were analysed in accordance with a uniform trial schedule. The regression of CDT values obtained by the two procedures was computed for each laboratory using the method of Passing and Bablok. Slopes and intercepts of the regression functions did not differ significantly from the values 1 or 0, as proved by the corresponding 95% confidence intervals. Precision studies were computed using analysis of variance. For CDT concentrations at the upper reference limit for men, the within-day coefficients of variation (CVs) ranged between 0.7 and 6.4% (median 5.2%) for CDTect-RIA and from 4.3 to 9.2% (median 6.2%) for CDTect-EIA. The corresponding pure between-day CVs were 5.0-18.5% (median 9.8%) and 3.5-14.5% (median 10.9%). The study demonstrates the equality of CDT values obtained by CDTect-RIA and CDTect-EIA. According to this study, the two methods can be used interchangeably without getting fluctuating CDT values, e.g. in longitudinal studies.

Carbohydrate-deficient transferrin: diagnostic efficiency among patients with end-stage liver disease before and after liver transplantation.

We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n = 147) and after (n = 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.

False-Positive CDTect Values in Patients with Low Ferritin Values

The determination of carbohydrate- deficient transferrin (CDT)—for example, by assays such CDTect® (Pharmacia & Upjohn)—currently is widely accepted as a valuable marker for the detection of chronic alcohol abuse (1)(2). The major reason for this is high specificity (>95%) in combination with good sensitivity (>75%). False-positive CDT determinations are scarce but do occur in patients with some liver diseases, with the rare genetic D variant of transferrin, and with the carbohydrate-deficient glycoprotein syndrome. Because it can be anticipated that the amount of CDT will also be influenced by the rate of transferrin synthesis, we studied CDT values measured by CDTect in a group of anemic patients with various causes and treatments and subsequently in nonanemic patients with low ferritin values. The study was approved by the Medical Ethical Committee of our hospitals. CDT (CDTect, Pharmacia & Upjohn; reference values <20 units/L for men and <26 units/L for women), ferritin (AxSYM, Abbott; reference values, 25–300 μg/L), serum iron (Hitachi 704, Boehringer Mannheim; reference values, 10–32 μmol/L), and transferrin …

Carbohydrate-deficient transferrin is not a useful marker for the detection of chronic alcohol abuse.

The role of carbohydrate-deficient transferrin (CDT) as a reliable marker for the detection of chronic alcohol abuse has been discussed controversially. Therefore, we investigated CDT in the sera from 405 subjects with different alcohol intake. Besides healthy control subjects (n = 42), inpatients and outpatients in a department of gastroenterology (n = 325) and patients admitted to a department of otorhinolaryngology (n = 38) were studied. A total of 213 patients suffered from various forms of liver diseases, and 89 patients had liver transplantation. CDT values were determined by a double-antibody radioimmunoassay. In the 241 alcohol-abstinent subjects, CDT levels ranged from 3 to 90 units L-1 (median = 12); the 92 moderate drinkers (20-60 g of alcohol per day) showed values from 3 to 40 units L-1 (median = 12), and the 72 subjects with chronic alcohol abuse (> 60 g per day) revealed CDT levels from 3 to 100 units L-1 (median = 16). The diagnostic specificity for alcohol abuse was 86.8% for men (sensitivity 36.9%) and 95% for women (sensitivity 0%). Our data indicate that measurement of CDT does not reach clinical use in the detection of chronic alcohol abuse in an unselected population because of its insufficient specificity and sensitivity.

Carbohydrate‐Deficient Transferrin and Conventional Alcohol Markers as Indicators for Brief Intervention among Heavy Drinkers in Primary Health Care

Brief intervention is a promising treatment for heavy drinking. The present study examined the diagnostic value of carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) in detecting early-phase heavy drinkers for brief intervention treatment in primary health care. Laboratory data were collected from consecutive 20- to 60-year-old, early-phase heavy drinkers (329 males and 136 females), who were willing to undergo brief intervention treatment in five primary health care outpatient clinics. An elevated value of at least 1 of the 5 markers studied was found in 75% of the male and in 76% of the female heavy drinkers. The sensitivities of CDT, MCV, AST, ALT and GGT values were low; in men, respectively, 39%, 28%, 12%, 28%, and 33%, and in women 29%, 40%, 20%, 29%, and 34%. However, marker combinations, including CDT, reached a good level of sensitivity; the best triple combination (CDT or MCV or GGT) was positive in 69% of the men and 70% of the women. According to logistic regression, the age of the patient had an increasing effect on MCV, ALT and GGT. High body mass index increased all transaminases and decreased CDT and MCV. Smoking increased MCV and decreased AST. Thus, primary health care marker combinations, especially those including CDT, should be considered for the detection of early-phase heavy drinkers for brief intervention treatment.

Carbohydrate-deficient transferrin (CDT) as preoperative alcohol marker in surgical risk patients

In a prospective study the preoperative risk of alcohol addiction was evaluated in 46 patients with squamous cell carcinoma of the esophagus. In all patients the alcohol marker carbohydrate-deficient transferrin (CDT) was measured prior to esophagectomy and correlated with the incidence of postoperative withdrawal symptoms (yes/no) and the postoperative course (good/moderate/poor/fatal). Withdrawal symptoms were more frequently observed in cases of elevated CDT values (median of CDT with withdrawal 17.0 U/l vs without withdrawal 10.7 U/l; P = 0.0006). CDT values were significantly increased in case of a complicated postoperative course (median of CDT for moderate/poor/fatal postoperative course 14.0 U/l vs good course 10.8 U/l; P = 0.02). The CDT value correlated (P = 0.04) with the patient's history of preoperative alcohol consumption (normal/increased/high). In a multivariate logistic regression analysis CDT and preoperative alcohol consumption were independent parameters to predict significantly the postoperative course and withdrawal. The sensitivity was 71.4% and the specificity 84.4% selecting the parameter "postoperative withdrawal" and a CDT cut-off point of < 15.3 U/l. CDT can effectively identify patients with high alcohol consumption prior to esophagectomy.

Isoforms and levels of transferrin, antithrombin, a1-antitrypsin and thyroxine-binding globulin in 48 patients with carbohydrate-deficient glycoprotein syndrome type I

Carbohydrate-deficient glycoprotein syndrome type I (CDGS I) is an autosomal recessive disease with multiple organ manifestations. The diagnostic biochemical marker has been typical carbohydrate-deficient isoforms of transferrin (Tf). Many other glycoproteins in blood may show similar defects, but have not been systematically studied before. Forty-eight CDGS I patients and 22 controls were examined for total concentrations and isoform distribution of Tf, antithrombin (AT), alpha(1)-antitrypsin (alpha(1)-AT) and thyroxine-binding globulin (TBG), and for the level of carbohydrate-deficient transferrin (CDT). The absolute values varied with age. The most frequent persistent quantitative changes were reduced levels of AT (97%) and elevated CDT values (100%). Isoforms lacking one to eight of four to eight possible sialic acid residues were found in AT, TBG and Tf in all cases, with variable intensity and frequency, and in all except one patient in alpha(1)-AT. The isoform changes were most constant and pronounced in Tf. The other three glycoproteins showed more abnormal heterogeneity in the youngest than in the older patients. The results indicated that the biochemical defect stabilizes with age, and suggested partial hypoglycosylation rather than non-glycosylation of these glycoproteins. Analysis of Tf isoforms is still the safest diagnostic marker of CDGS I from full-term birth and over the ages.

Utility of Biological Markers during Outpatient Treatment of Alcohol‐Dependent Subjects: Carbohydrate‐Deficient Transferrin Responds to Moderate Changes in Alcohol Consumption

A group of 25 alcohol-dependent subjects in outpatient treatment were monitored for a period of 4 weeks. They were weekly interviewed for their alcohol consumption and their serum levels of carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GT) were analyzed. The majority of the patients reported an excessive and fairly constant alcohol intake during the observation period. When selecting those patients that reported periods of 1 or 2 weeks with moderate changes in alcohol consumption, corresponding changes in CDT were demonstrated. Thus, of 14 patients reporting an increased alcohol consumption for 2 weeks (mean values increased from 57 to 101 g/day), 11 showed an increase in CDT at the end of the period. The mean CDT value of all 14 increased from 5.5 to 6.7% (p < 0.05). Slight, but not significant, increases were noted in GT, indicating that CDT is more sensitive than GT in detecting increased alcohol consumption. Furthermore, of 17 patients that reported decreased alcohol consumption for one or several weeks, 14 showed decreased CDT and GT values. The mean values of all 17 were reduced from 5.1% to 4.5% (CDT) and from 126 units/liter to 97 units/liter (GT) (p < 0.05 for both parameters). The results indicate that CDT responds to moderate changes in alcohol consumption in alcohol-dependent patients and may thus be useful as a corrective tool to self-reports of alcohol consumption during outpatient treatments.

Der neue ,,Alkoholmarker" carbohydratdefizientes Transferrin (CDT)

Many alcoholics deny any abuse, and hence it is often difficult to diagnose alcohol abuse. Laboratory parameters, such as gamma-glutamyltransferase (gamma-GT) and the mean corpuscular volume of erythrocytes (MCV), are often used to diagnose recent high alcohol intake. However, these parameters indicate elevated alcohol consumption only indirectly, e.g. if the elevation is due to an organ lesion caused by alcohol. In recent literature, CDT (carbohydrate-deficient transferrin) has been suggested as a most promising laboratory parameter indicating noxious alcohol consumption. The clinical value of CDT is compared to other "alcohol markers". CDT has the highest sensitivity and specificity in selected samples taken from alcoholics. However, the sensitivity of CDT is rather low in population surveys. Thus, CDT cannot be recommended for the screening of alcoholics. Furthermore, in view of the high cost of measurement, a close indication for application is urgent. Some examples of an indication in neurological and psychiatric diagnostics are critically discussed.

Serum carbohydrate-deficient transferrin in patients with nonalcoholic liver disease and with hepatocellular carcinoma

Serum carbohydrate-deficient transferrin (CDT) is used as a reliable and specific marker of alcohol consumption. However, recent studies have shown false-positive CDT test results in nonalcoholic liver disease. We examined the clinical significance of serum CDT in nanalcoholic liver disease, especially hepatocellular carcinoma. Serum CDT was measured in 23 teetotallers, 56 patients with alcoholic liver disease, 84 patients with viral liver disease and 67 patients with hepatocellular carcinoma, with an Axis %CDT radioimmunoassay kit, and the results were expressed as percentages of the total transferrin (%CDT). The mean serum %CDT value was increased 1.8-fold in alcoholic liver fibrosis and 3.8-fold in alcoholic liver cirrhosis compared with the teetotallers. The serum %CDT values in viral chronic hepatitis were similar to those of the teetotallers, and were increased 2.0-fold in viral liver cirrhosis. False-positive results were found in 10 (37%) of the 27 patients with viral liver cirrhosis. The mean serum %CDT value was increased 2.5-fold in hepatocellular carcinoma, and false-positive results were found in 31 (46%) of the 67 patients. The serum %CDT value was related to the severity of Child grade, the size of tumor and the grade of histological differentiation. These results suggest that the ability of serum CDT test to detect chronic alcoholism may be reduced in patients with nonalcoholic liver cirrhosis and those with hepatocellular carcinoma.

Superiority of carbohydrate-deficient transferrin to gamma-glutamyltransferase in detecting relapse in alcoholism.

The usefulness of carbohydrate-deficient transferrin is widely accepted in screening (male) population samples for heavy alcohol consumption, but its role in relapse detection is not convincingly established. The authors therefore compared the diagnostic value of carbohydrate-deficient transferrin with the commonly used gamma-glutamyltransferase in identifying relapsed alcoholics during outpatient aftercare. The patients were 101 male alcoholics who entered a 6-month rehabilitation program after hospital detoxification. Drinking status was assessed by means of self- and collateral reports obtained during regular contacts with the rehabilitation team; relapse was defined as consumption of any alcohol. Visits occurred weekly during month 1, biweekly during month 2, and every 4 weeks during months 3-6. At every visit a blood sample was taken for measurement of carbohydrate-deficient transferrin and gamma-glutamyltransferase. The proportion of men who reported relapse was 25.6% per scheduled contact on average. Positive predictive values indicated that relapse was identified with a 76.2% probability by carbohydrate-deficient transferrin values above the upper normal limit, in contrast to a 32.9% chance with gamma-glutamyltransferase. Carbohydrate-deficient transferrin was especially useful in detecting early relapses during the initial rehabilitation phase, when gamma-glutamyltransferase values had not normalized. Because of the longer half-life of gamma-glutamyltransferase, it had some value with a 4-week monitoring schedule in detecting new drinking episodes in alcoholics whose previous results had been normal. Carbohydrate-deficient transferrin proved to be superior to gamma-glutamyltransferase in relapse detection in an outpatient care setting for alcoholics.

Carbohydrate-deficient transferrin in healthy women: relation to estrogens and iron status.

The determination of carbohydrate-deficient transferrin (CDT) in serum has been found useful as a marker of increased alcohol consumption of > 60 g/day. It is not clear why the reference range is different for women (0 to 26 units/liter) and men (0 to 20 units/liter). We evaluated serum CDT in 286 healthy subjects (209 women, 77 men) using a commercially available radioimmunoassay. Premenopausal women had higher CDT levels than postmenopausal women, whereas no age-related difference of CDT levels was found in men. In postmenopausal women, higher CDT levels were associated with estrogen replacement therapy. In premenopausal women, however, neither the phase of the menstrual cycle nor contraceptive steroid use showed a significant association with the increase in CDT levels. No significant correlations were found between CDT and either serum estradiol or serum iron. In conclusion, both premenopausal state and postmenopausal estrogen replacement therapy seem to increase serum levels of CDT. Therefore, menopausal status and exogenous estrogens should be considered when interpreting CDT values in women.

Alcohol dependence: is carbohydrate-deficient transferrin a marker for alcohol intake?

We investigated %CDT (carbohydrate-deficient transferrin) in 92 ethanol-intoxicated alcohol-dependent patients after consecutive admission to hospital and followed the for 28 days under controlled conditions. At admission, 63% (58 patients) showed elevated CDT (> 2.5%) and 34 patients (37%) had normal CDT levels (< 2.5%). No correlation of the %CDT values to alcohol-related disabilities, severity of the withdrawal syndrome, alcohol-drinking pattern before admission, or several other factors was found. The sensitivity of GGT (gamma-glutamyl transferase) was 58% for the same group of patients. Levels of %CDT decreased during the 28 days following abstinence, whereby we could separate four statistically different groups of "CDT decrease'. In two of these groups, comprising most of the cases studied, normal %CDT levels were reached after 14 days of abstinence. Those patients with %CDT levels exceeding the upper normal level after 14 days of sobriety, showed a decrease during the following 14 days to levels of 2.55-2.61%.

Carbohydrate-deficient transferrin evaluation in dry blood spots.

The aim of this study was to assess the performance of the isoelectric focusing/immunoblotting/laser densitometry (IEF/IB/LD) procedure to evaluate carbohydrate-deficient transferrin (CDT) derived from dry blood spots. Serum specimens obtained from insurance applicants were analyzed for CDT by IEF/IB/LD. Dry blood spots derived from 50 serum specimens were analyzed by IEF/IB/LD. A comparative analysis of these serum specimens and the paired dry blood spots by IEF/IB/LD shows a highly significant correlation of the CDT values (r = 0.94, p < 0.0001). Stability studies indicate that, under proper storage conditions (2-3 days at room temperature, 2 weeks at 4 degrees C, or frozen at or below -20 degrees C indefinitely), dry blood spots can be used as a source of CDT for analysis by IEF/IB/LD, thus simplifying sampling, storage, and transportation of specimens to the testing site.

LONGITUDINAL COMPARISON OF CARBOHYDRATE-DEFICIENT TRANSFERRIN AND GAMMA-GLUTAMYL TRANSFERASE: COMPLEMENTARY MARKERS OF EXCESSIVE ALCOHOL CONSUMPTION

The utility of carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (GGT) as biochemical markers of excessive alcohol consumption was studied in alcohol-dependent subjects. Serum samples were collected once weekly from 10 male out-patients undergoing a 6-month alcohol treatment programme. Frequency of relapse into drinking (defined as any intake of alcoholic beverage) was assessed by self-reports during patient interviews three times per week and by daily determination of the 5-hydroxytryptophol level in urine. A marked decrease in mean CDT and GGT values was observed during the initial month. Only one patient remained totally abstinent throughout the observation period, while four had sporadic relapses (2-5 days with alcohol consumption). Both CDT and GGT remained below the respective reference limits in those patients. The other five patients drank more frequently (range 22-57 days) and increased their mean levels of CDT and GGT after the initial decrease. As determined from the values at admission and during the course of the study, CDT appeared to be the most sensitive marker in six out of the 10 patients. In one patient, both markers were affected in a parallel way, whereas two of those with frequent relapses responded to alcohol consumption with a marked increase in GGT, but with no or only a slight increase in CDT. One patient did not show any abnormal CDT or GGT values. In 54 female and 60 male serum samples collected at random from patients during admission at an alcohol detoxification unit, 35% and 58% of the CDT values exceeded the reference limits for females and males, respectively. For GGT, 59% of the female and 67% of the male values were above cut-off. Carbohydrate-deficient transferrin and GGT were not significantly correlated. Taken together, the present results indicate that measurement of both CDT and GGT will increase the possibility of identifying excessive alcohol consumption. By following changes in CDT and GGT values during a period of alcohol withdrawal, the most sensitive individual marker can be determined. This in turn allows for improved detection of relapse into heavy drinking during long-term monitoring of out-patients.

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

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.

Carbohydrate‐Deficient Transferrin as a Marker of Alcohol Abuse: Relationship to Alcohol Consumption, Severity of Liver Disease, and Fibrogenesis

Carbohydrate-deficient transferrin (CDT) measurements have been widely examined as a marker of excessive alcohol consumption, yet the information on the sensitivity of this method has remained controversial. In addition, little is known of the relationship of this marker and the severity of alcoholic liver disease (ALD). To clarify these issues, we analyzed serum samples from 373 alcohol abusers, including 200 problem drinkers with no apparent liver pathology, 173 patients with clinical or morphological evidence of ALD, and 42 healthy controls. CDT was analyzed by anion-exchange chromatography followed by radioimmunoassay. At a specificity of 100%, the sensitivity of CDT was 36% in problem drinkers reporting a mean of 710 +/- 80 (mean +/- 2SE) g of ethanol/week, as compared with the sensitivities of 44% and 35% for gamma-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV), respectively. In a subgroup of problem drinkers (n = 51) with the highest ethanol intakes (1160 +/- 180 g of ethanol/week) and severe dependence, the sensitivity of CDT increased to 64%, compared with 55% for GGT and 39% for MCV. In ALD, the CDT values were significantly higher than in the alcoholics with nonliver pathology. However, when such patients were classified according to the clinical, laboratory, and morphological severity of liver disease, CDT was found to be primarily elevated in those with the early stage of ALD, such that there was a significant negative correlation between CDT and the combined morphological index of disease severity (rs = -0.315, p < 0.05). ALD markers of fibrogenesis were elevated more frequently than CDT, showing significant positive correlations with the indices of disease severity.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of carbohydrate-deficient transferrin as a marker of relapse in alcoholic patients.

Carbohydrate-deficient transferrin (CDT) has been proposed as a marker of alcoholism. However, its role in monitoring alcoholic patients for relapse has not been extensively studied. We therefore performed sequential serum CDT measurements using a microcolumn/radioimmunoassay method (Kabi Pharmacia, Piscataway, NJ) in 86 male alcoholics participating in a hepatitis vaccination program who were monitored for relapse using self-report and collateral history (when available). The maximum serum CDT was significantly higher in patients who relapsed (n = 38) (33.1 +/- 3.1 mg/liter), as compared with abstinent subjects with collateral verification (n = 39) (18.8 +/- 1.3, p < 0.001) and abstinent patients without collateral verification (n = 9) (17.4 +/- 1.3, p < 0.01). Using the manufacturer's currently recommended threshold of 20 mg/liter for males, serum CDT was elevated in 29 of 38 patients who relapsed (sensitivity 76.3%). In 16 (42.1%) of the relapsed patients, a serum CDT above this threshold preceded the patient's self-report by at least 28 days. However, serum CDT exceeded 20 mg/liter in 10 of 48 patients who remained sober (specificity 79.2%); three of these patients had clinical and/or pathological evidence of cirrhosis. Using a threshold of 25 mg/liter, 21 of 38 patients who relapsed had an elevated serum CDT (sensitivity 55.3%); 12 (31.6%) of these patients had elevated serum CDT before self-report. Only 4 of 48 subjects who remained sober had serum CDT levels that exceeded 25 mg/liter (specificity 91.7%); three of these patients had clinical and/or pathological evidence of cirrhosis. In conclusion, serial serum CDT testing detects relapses before self-report in male subjects. Values between 20-25 mg/liter suggest relapse, but call for collateral verification, whereas CDT values above 25 mg/liter are usually diagnostic of relapse in the absence of cirrhosis.