Validity of carbohydrate‐deficient transferrin (%CDT), γ‐glutamyltransferase (γ‐GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for chronic alcohol abuse: a study in patients with alcohol dependence and liver disorders of non‐alcoholic and alcoholic origin

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Abstract
Aim To test the clinical performance of carbohydrate‐deficient transferrin (%CDT), γ‐glutamyltransferase (γ‐GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for alcoholism with a special focus on patients suffering from liver diseases. Design Well‐characterized collectives of alcohol‐dependent patients with current consumption (ALC patients, n = 101), and relevant control groups (115 social drinkers, 46 patients with unspecifically increased γ‐GT, 51 hepatitis patients and 20/31 patients with non‐alcohol/alcohol‐dependent liver cirrhosis) were included into the study. The Positive Alcohol Use Disorders Test (AUDIT) score, International Classification of Diseases version 10 (ICD‐10)/Diagnostic and Statistical Manual version IV (DSM‐IV) criteria and blood drawn within 4 days of last drinking were inclusion criteria for subjects with regular heavy drinking. %CDT was determined using an automated assay which recently had been completely modified. Findings Median AUDIT scores of patients without/with regular heavy drinking were 1–3/27. The following medians/95th percentiles were obtained for %CDT: social drinkers 2.2/3.0, patients with unspecifically increased γ‐GT 2.1/3.0, hepatitis 2.0/4.4, non‐alcohol‐dependent liver cirrhosis 2.4/4.8, alcohol‐dependent liver cirrhosis 3.0/5.9, ALC patients 3.9/14.9. Differences between patients without and with alcohol abuse were highly significant (P < 0.001). No differences in CDT values were found between males and females. There was no correlation between %CDT values, γ‐GT, MCV and the amount of alcohol consumed in ALC patients; 3.0%CDT (95th percentile social drinkers) is proposed as cut‐off for the test used (Tina‐quant®%CDT 2nd‐generation). At this cut‐off, the sensitivity for ALC patients was 73.3%, whereas γ‐GT/MCV had a sensitivity of 71.3%/64.4%. Multivariate analysis performed at 95% specificity resulted in an improvement of the sensitivity by combining %CDT with γ‐GT (83.2%). A further enhancement of the sensitivity to 88.1% was obtained by combination of %CDT, γ‐GT and MCV. The diagnostic specificity of %CDT calculated at the cut‐off of 3% was 93.5% in patients with unspecifically increased γ‐GT, 88.2% in hepatitis patients and 70.0% in patients with non‐alcohol‐dependent liver cirrhosis. %CDT was more specific in these patient collectives than MCV, and especially more than γ‐GT (specificity in hepatitis 52.9%, and 35.0% in non‐alcohol‐dependent liver cirrhosis). Conclusion %CDT is of high diagnostic value to support diagnosis of alcohol‐use disorders. The specificity of this marker in patient groups with liver disorders is superior to the biomarkers γ‐GT and MCV.

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