title: Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers.
abstract: OBJECTIVE
  Carbohydrate 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.
  
  
  METHODS
  Patients 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.
  
  
  RESULTS
  52 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).
  
  
  CONCLUSIONS
  CDT 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.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Fagan
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Irvine
authors.forename: Brett C
authors.initials: BC
authors.lastname: McWhinney
authors.forename: Linda M
authors.initials: LM
authors.lastname: Fletcher
authors.forename: Leigh U
authors.initials: LU
authors.lastname: Horsfall
authors.forename: Lambro
authors.initials: L
authors.lastname: Johnson
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.forename: Ian
authors.initials: I
authors.lastname: Scott
authors.forename: Carel J
authors.initials: CJ
authors.lastname: Pretorius
authors.forename: Jacobus P J
authors.initials: JP
authors.lastname: Ungerer
authors.affiliation: Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba 4102, Brisbane, Queensland, Australia. e.powell@uq.edu.au.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Powell
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000378:metabolism*; D000437:Alcoholism / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014168:Transferrin / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D014168:Transferrin; C056759:carbohydrate-deficient transferrin