title: The use of biological laboratory markers in the diagnosis of alcohol misuse: an evidence-based approach.
abstract: BACKGROUND
  A large number of patients seen in clinical practice have an underlying alcohol problem. There is a pressing need for accurate methods to diagnose alcohol over-consumption objectively. Our aim was to determine how best to use biological markers to objectify alcohol problems in patients with clinical suspicion of alcohol misuse.
  
  
  METHODS
  A 6-month longitudinal multicenter trial was conducted, using four study groups (alcohol abusers, alcohol-dependents, healthy controls and consulting controls). CDT, GGT and MCV were measured. Statistical analyses used a computer learning system that created classification systems displayed in decision trees.
  
  
  RESULTS
  In 379 subjects the marker that best discriminated those with alcohol problems from controls was CDT. GGT then helped to differentiate between alcohol abuse and alcohol dependence in cases of high CDT. MCV, age and gender provided no extra information.
  
  
  CONCLUSIONS
  We recommend CDT as a first-line biological marker to confirm or disprove suspected alcohol misuse. High CDT plus GGT above normal points to alcohol dependence, while high CDT plus GGT below normal is evidence of alcohol abuse.
authors.affiliation: Department of Psychiatry, University Medical School, Clermont-Ferrand, France. rschwan@chu-clermontferrand.fr
authors.forename: Raymund
authors.initials: R
authors.lastname: Schwan
authors.forename: Eliane
authors.initials: E
authors.lastname: Albuisson
authors.forename: Laurent
authors.initials: L
authors.lastname: Malet
authors.forename: Marie-Nadia
authors.initials: MN
authors.lastname: Loiseaux
authors.forename: Michel
authors.initials: M
authors.lastname: Reynaud
authors.forename: François
authors.initials: F
authors.lastname: Schellenberg
authors.forename: Gorges
authors.initials: G
authors.lastname: Brousse
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: Llorca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood* / Q000175:diagnosis*; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003663:Decision Trees; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers