Specificity Of Carbohydrate-deficient Transferrin Research Articles

Benefit of carbohydrate deficient transferrin in detecting chronic alcohol abuse in the elderly: study protocol for a multicentre, non-randomized, open-label study

Background: Alcohol misuse affects about five million people in France. Self-reported alcohol consumption, questionnaires, biological markers like gamma-glutamyltranspeptidase (GGT), mean corpuscular volume (MCV) and carbohydrate deficient transferrin (CDT) are usually used to detect alcohol abuse. As a biological marker of alcohol misuse, the specificity of the CDT is known to be superior to GGT and MCV as well. The elderly may suffer from this pathology, but its clinical and biological detection and management are often difficult, due to a frequent denial of the alcoholism and multiple chronic diseases. Methods/Design: A prospective, multicentre, non-randomized, open-label will be performed in the Geriatrics Department of the Hospital of Mulhouse, Alsace and in an Alsatian health care network. Inclusion criteria are: age ≥ 60 years, patients hospitalized for 1 day or 1 week in the Geriatrics department or new patients of the health care network, presence of a suitable relative or helper. A total of 200 enrolled patients are expected. Alcohol consumption will be detected by the Alcohol Use Disorder Identification Test - Consumption questionnaire. This questionnaire will be submitted to the patient and to a relative. If one of the two scores ≥ 1, a CDT analysis may be performed. Primary outcome is the benefit of CDT in the detection of chronic alcohol abuse in the elderly as compared with usual clinical detection tools. Secondary outcomes are sensitivity and specificity of disturbance of GGT and MCV in case of alcohol consumption and identification of socio-economic characteristics of alcohol abusers (socio-professional category, education level, way of life and environment). Discussion: Findings of this trial will probably show low sensitivity and specificity of CDT to detect chronic alcohol misuse in the elderly. Those results suggest that biological markers are not more effective than questionnaires and medical interview to detect alcohol abuse, even if the consumption is initially denied. If confirmed, the results should improve medical screening, diagnosis and care in case of alcohol abuse in the elderly and reduce costs of biological analysis. Trial registration: ClinicalTrials.gov identifier: NCT02822911, registered on 30 June 2016. Ethics: The Committee for the Protection of Persons located in Strasbourg, France, delivered a favourable opinion on the study project. Informed consent: The physician or the health network's care coordinator informs the patient about the study protocol and obtains the patient's assent. The investigator completes a non-opposition file and a copy is given to the patient and to his/her relative or helper.

Carbohydrate deficient transferrin in doping and non-doping sportsmen

The determination of carbohydrate deficient transferrin (CDT) concentration is primarily used in social security studies as a proof of regular alcohol consumption exceeding the amount of 60 grams per day. Aims: The present study was performed to investigate into how carbohydrate deficient transferrin CDT values in serum are affected by the so-called food supplements and chemicals included in doping lists. Methods: The investigation was carried out in 15 bodybuilders of two sport clubs and in 10 boxers. All sportsmen were males. In both groups serum carbohydrate deficient transferrin (CDT%), median red blood cell volume and (MCV) gamma-glutamyl-transpeptidase (GGT) values were measured. Results: The authors found a significant difference between the two groups only in carbohydrate deficient transferrin CDT% that was the CDT% value in bodybuilders was twice as high as in boxers. Conclusion: Not all the details of the specificity of carbohydrate deficient transferrin (CDT) concentration are known, however, the remarkably high sensitivity of the method makes it suitable and probably cost-financially effective for serving as a pre-screening tool in doping tests. Orv. Hetil., 2012, 153, 514–517.

Sensitivity and specificity of carbohydrate-deficient transferrin in drinking experiments and different patients

Information provided by patients about the amounts of alcohol they drink may often be too subjective and therefore unreliable. Because of the possible serious consequences of interactions between alcohol and medication, reliable laboratory test markers for alcohol consumption are needed. Carbohydrate-deficient transferrin (CDT) is at present the best available objective measure of drinking behavior. During a withdrawal trial, 92 alcohol-dependent patients who had been admitted to a hospital in an ethanol-intoxicated state were monitored over the following 28 days by using the percent carbohydrate-deficient transferrin (%CDT of total transferrin) (%CDT) method. At the time of admission, 63% showed elevated %CDT levels. After a subsequent period of abstinence, a decrease in %CDT levels was apparent in four different groups of patients, whereas in two groups, comprising the greatest number of patients, normal %CDT levels were evident after 14 days of abstinence. In patients whose CDT levels were very high at study initiation, it took at least 21 to 28 days—and sometimes longer—for CDT to decrease to the radioimmunoassay (RIA) %CDT test cutoff point of 2.5. In a further study of 56 male alcohol-dependent patients, we measured liver enzyme concentrations, mean corpuscular volume (MCV), and four CDT variants on the first day of evidence of withdrawal syndrome. We found a significant correlation between results on the Munich Alcoholism Test (MALT) and MCV levels; among gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels; and among all four CDT variants. A cluster analysis yielded three clusters: (1) GGT, AST, and ALT levels; (2) MCV levels and MALT results; and (3) all CDT measurement variants. We conclude that these three clusters measure different detriments to the patient and that all available CDT variants are commensurate.

Le dosage de la transferrine déficiente en acide sialique avec le test immunoturbidimétrique Axis % CDT

Carbohydrate-deficient transferrin determination with Axis % CDT turbidimetric immunoassay. Carbohydrate-deficient transferrin (CDT) may now be suggested the most valuable marker for diagnosis of alcohol abuse. The aim of our study was to evaluate the Axis % CDT assay ; this method is based on anion exchange chromatography in disposable microcolumns followed by a turbidimetric immunoassay, performed with Array Protein System ® and a Cobas Mira ®. Sensitivity and specificity of the CDT-test were evaluated from a population of 128 subjects : 53 control subjects (daily alcohol intake < 20 g), 29 chronic ethylic subjects (daily alcohol intake > 40 g), 24 non alcoholic patients with chronic hepatitis C, 22 patients with hepatitis C and alcohol abusers. The diagnostic performance of CDT-test was compared with conventional markers (γGT, MCV). Imprecision of the assay was judged to be satisfactory : intra-assay coefficients of variation (CV) were 4.4 % and 3.3 % respectively on the Cobas Mira ® and Array ®, inter-assay CV ranged between 7.8 % and 11.6 %. Results of the two automates were compared for 116 sera ; a good correlation was obtained (r = 0.970, p < 0.001), however Array ® % CDT were systematically lower than Cobas Mira ® % CDT (difference between 0 and 3 %). The upper limit of reference range established in control group was 4 % on Array ® and 5.7 % on Cobas Mira ®; the difference between males and females results was not statistically significant. Sensibility of % CDT (72 % in chronic ethylic subjects) was lower than for the two other markers, γGT being the most sensible parameter (85 %). On the other hand, specificity of CDT was high (87.8 % in the whole population), reaching 100 % in the group of alcoholic patients with hepatitis C, whereas specificity of γGT and of MCV are 50 % and 77 % respectively.

Transferrina carbohidrato-deficiente, gammaglutamil transferasa y volumen corpuscular medio en la evaluación de la ingesta alcohólica reciente de bebedores excesivos

There are no reliable markers to detect heavy drinking or as a tool to control abstinence compliance in alcoholic treatments. The Mean Corpuscular Volume (MCV), and the gammaglutamyl transpeptidase (GGT), are widely used although their predictive value is somewhat limited due to their low specificity. On the other hand, the Carbohydrate-deficient transferrin (CDT) described in the eighties is highly specific and would be of value in early detection of problem drinking. To compare the sensitivity and specificity of CDT, GGT, and MCV in order to evaluate their single and combined use as markers for detection of heavy drinking behaviour. CDT, GGT, and MCV values were determined in blood samples from (a) alcoholics (drinking more than 100 9 alcohol/day; n = 47) and (b) healthy volunteers, teetotalers from the Church of Saints of Later Days (n = 34). At the time of sampling alcoholics were presently drinking or had been abstinent for no more than six weeks. ROC curves were used to determine the best cut-off point for each marker. Sensitivity was found to be similar for all three markers. Specificity was found higher for GGT (90.9%) and CDT (91.0%). The combined use of MCV, GGT and CDT, that is, when at least one of the markers is altered, was shown to detect 83% of the patients. No correlation was observed between the markers and the level of alcohol intake. CDT could be of value as a marker to detect heavy drinking when used with GGT and MCV values combined. CDT is particularly higher in drinking alcoholics and remains significantly high for at least six weeks after they stop drinking.

A comparative study between carbohydrate-deficient transferrin and gamma-glutamyltransferase for the diagnosis of excessive drinking in a liver unit

Aims: To compare the efficacy of carbohydrate-deficient transferrin and gamma-glutamyltransferase for the diagnosis of excessive alcohol intake in patients admitted in a liver unit. Methods: The 346 patients were divided into three groups of alcoholics: 57 patients (31 men, 26 women) with a normal liver, 77 patients (51 men, 26 women) with non-cirrhotic alcoholic liver disease, and 61 patients (43 men, 18 women) with alcoholic cirrhosis; and three groups of non-alcoholics: 35 abstainers (21 men, 14 women), and 58 healthy blood donors (26 men, 32 women), and 58 patients (32 men, 26 women) who had a non-alcoholic liver disease. Carbohydrate-deficient transferrin and gamma-glutamyltransferase were measured at admission using commercially available kits. Results: Carbohydrate-deficient transferrin was more sensitive than gamma-glutamyltransferase in patients without alcoholic liver disease, in both men (85 vs 54%) and women (64 vs 36%). Carbohydrate-deficient transferrin sensitivity decreased slightly but not sigficantly according to the severity of the liver disease in men and women. The sensitivity of gamma-glutamyltransferase which was low in men and women without alcoholic liver disease, improved in groups with moderate or severe alcoholic liver disease: not less than 80% in men and up to 100% in women. The specificity of carbohydrate-deficient transferrin in patients with non-alcoholic liver disease was consistently higher than that of gamma-glutamyltransferase (80% vs 60%). Conclusions: In liver units, carbohydrate-deficient transferrin can help to identify excessive drinkers without liver disease with a higher efficacy than that of gamma-glutamyltransferase; carbohydrate-deficient transferrin can also be used to distinguish between alcoholics with moderate liver disease and patients with non-alcoholic liver diseases.

REPLY: SUPERIOR DIAGNOSTIC ACCURACY OF CARBOHYDRATE-DEFICIENT TRANSFERRIN OVER GAMMA-GLUTAMYLTRANSFERASE

In his letter, Dr Rosalki (1996) criticizes our claim (Stauber et al, 1995) of superior sensitivity of carbohydrate-deficient transferrin (CDT) over that of gamma-glutamyltransferase (gamma-GT). It was not our intention to claim that sensitivity of CDT alone is superior to that of gamma-GT, but that sensitivity and specificity of CDT together, and thus its overall diagnostic accuracy, are superior. For comparison of CDT with gamma-GT, we analysed only data obtained from outpatients who had various kinds of chronic liver disease, but were not preselected because of an elevated gamma-GT. As can be seen in Table 2 of our article (Stauber et al., 1995), the sensitivities of CDT (85%) and gamma-GT (83%) were comparable, while the specificity of CDT (83%) was superior to that of gamma-GT (16%). These findings are consistent with a previous study by Bell et al. (1993), who reported sensitivities of 61% for CDT and 85% for gamma-GT and specificities of 92% for CDT and 18% for gamma-GT. Based on these data, it may be clearly concluded that overall diagnostic accuracy of CDT is superior to that of gamma-GT in patients with liver disease.

Carbohydrate-deficient transferrin in alcohol and nonalcohol abusers with liver disease.

Carbohydrate-deficient transferrin (CDT) has been demonstrated to be a marker of prolonged heavy alcohol consumption. We compared this marker with gamma-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV) in alcohol and nonalcohol abusers with liver disease. Our results confirm that the sensitivity of CDT in alcoholics is high, although lower than that of GGT and MCV; however, the specificity of CDT was higher than that of the other two markers. This finding supports the notion that CDT is only partially influenced by the presence of liver damage, whereas increases of GGT and MCV are greatly affected by several factors, including liver damage and drugs. Moreover, we observed that the sensitivity and the specificity of CDT were greater than those of GGT and MCV in younger drinkers.

EVALUATION OF CARBOHYDRATE-DEFICIENT TRANSFERRIN FOR DETECTION OF ALCOHOL ABUSE IN PATIENTS WITH LIVER DYSFUNCTION

The determination of carbohydrate-deficient transferrin (CDT) in serum has been suggested as a marker of alcohol abuse. We evaluated serum CDT in 199 patients admitted to our Department of Medicine using a commercially available radioimmunoassay kit for CDT. A history of alcohol consumption was obtained quantitatively by a self-administered questionnaire and qualitatively by the Munich Alcoholism Test. Using a cut-off level of 60 g ethanol per day according to the information from the questionnaire. CDT had a sensitivity of 70% and a specificity of 84%. False-positive values were primarily encountered in cases of hepatic malignoma, primary biliary cirrhosis and chronic hepatitis C. The sensitivity and specificity of CDT was superior to two other markers of chronic ethanol consumption, serum gamma-glutamyltransferase and mean cell volume, and thus proved to be the best single laboratory test for the detection of alcohol abuse.

Carbohydrate-deficient transferrin and other markers of high alcohol consumption: a study of 502 patients admitted consecutively to a medical department.

An isoform of transferrin, carbohydrate-deficient transferrin (CDT) is increased in a high percentage of abusing alcoholics and has been found superior in its specificity compared with other biological markers. We used serum CDT as a screening parameter in 502 patients consecutively admitted to our medical department during a 4-week period. The intake of ethanol during the last 4 weeks was registrated by personal interviews and the mean daily consumption calculated. Serum CDT was measured at admission (CDTect) and compared with gamma-glutamyltranspeptidase (GGT), AST, ALT, and mean corpuscular volume (MCV). Serum CDT detected 18 of 26 (69%) patients who consumed > 50 g ethanol daily. The clinical sensitivity of CDT of detection ethanol consumption > 50 g daily was 69%, compared with 73%, 50%, 35%, and 52% for increased values of GGT, AST, ALT, and MCV, respectively. Altogether, 38 of 476 patients (8%) with a daily ethanol consumption < 50 g also had increased serum CDT levels. The specificity of CDT was 92%, compared with 75%, 82%, 86%, and 85% for GGT, AST, ALT, and MCV, respectively. In the 60 patients who consumed > 10 g ethanol daily, we found a significantly positive correlation between CDT and ethanol consumption (r = 0.52, p < 0.001). A positive correlation was also found between serum transferrin and CDT (r = 0.51, p < 0.001). In conclusion, the specificity of CDT is much higher compared with GGT in detecting alcohol abuse. Some acute and chronic illnesses may increase the serum level of CDT. False-positive CDT levels may be caused by changes in serum transferrin concentration.

Carbohydrate-deficient transferrin as an alcohol marker among female heavy drinkers: a population-based study.

Carbohydrate-deficient transferrin (CDT) has previously been reported to be an excellent marker of male alcoholics. Less is known of its efficiency among women and especially of early-phase alcohol abuse in nonselected populations. The present population-based study examined the diagnostic value of CDT among consecutive women, including 13 teetotallers, 135 social drinkers (mean alcohol consumption 45 +/- 34 g/week), and 57 nonalcoholic heavy drinkers (197 +/- 97 g/week). Sixty-two women with a well-documented history of chronic alcoholism (942 +/- 191 g/week) were also studied, as well as 36 pregnant women used as a reference group. Two weeks of abstinence among 11 alcoholics was followed. The CDT (containing part of isotransferrin with pI = 5.7, 5.8, and 5.9) was separated by anion exchange chromatography and assayed by radioimmunoassay. In the whole material, CDT correlated significantly with alcohol consumption (r = 0.43, p < 0.001) but not with conventional markers (gamma-glutamyltransferase, AST, ALT, and mean corpuscular volume). The CDT values of alcoholics (34 +/- 20 units/liter) were significantly (p < 0.001) higher than those of teetotallers (19 +/- 6 units/liter), social drinkers (20 +/- 6 units/liter), or pregnant women (16 +/- 3 units/liter). Heavy drinkers also had higher values (25 +/- 13 units/liter), but the difference did not reach statistic significance. The specificity of CDT was on the level of conventional markers when the cut-off value was increased from 26 to 29 units/liter. At a specificity of 95%, CDT found 19% of the heavy drinkers and 52% of the alcoholics; the best traditional marker, AST, with a specificity of 97%, found 7% and 56%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood tests for detection of alcoholic cause of acute pancreatitis

We investigated the ability of various blood markers to detect an alcoholic cause of acute pancreatis. Serum carbohydrate-deficient transferrin (CDT) was significantly correlated with reported 2 month and 7 day ethanol consumptions and was significantly higher in 42 patients with alcoholic acute pancreatitis and in 24 patients with possibly alcoholic acute pancreatitis than in 20 patients with non-alcoholic disease. At a cutoff over 17 U/L, the specificity of CDT was 100% and the sensivity was 75% to detect an alcoholic cause of acute pancreatitis. —The lipase/amylaseratio index, erythrocyte mean corpuscular volume, and gamma glutamyl transferase could not distinguish alcoholic from non-alcoholic acute pancreatitis. Lancet 1994; 343: 1328–29