Gordon, Harriet M; (2000) Serum carbohydrate deficient transferrin as a marker for alcohol abuse. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Aim: To examine serum carbohydrate-deficient transferrin (CDT) as a marker of alcohol abuse and to determine possible reasons for false positive and false negative results. Background: Alcohol misuse constitutes a major problem for medical and social agencies world-wide. Early detection and meticulous monitoring of drinking behaviour in individuals, once identified, remain the mainstays of effective management. Objective markers are required to facilitate this process. Serum CDT has been proposed for this purpose but the performance of the available commercial kits appears to fall short of the more sophisticated HPLC techniques used for research purposes. Methods: Two commercial assays, CDTect (Pharmacia & Upjohn, Sweden) and AXIS %CDT (AXIS Biochemicals ASA, Norway), were used. Results: In a study population of 590 individuals with well-documented and widely divergent drinking behaviour the sensitivity/specificity of serum CDT was 47.9% and 78.4% (CDTect) and 47.9% and 90.3% (AXIS %CDT). The false positive rates in patients with non-alcoholic liver disease, 26.4% (CDTect) and 7.7% (AXIS %CDT), and the false positive and false negative rates in alcohol misusers, 33.6 / 52.1% (CDTect) and 25.5 / 52.1% (AXIS %CDT) were unacceptably high. An additional 363 individuals were studied with similar results. Monitoring performance was assessed in 40 alcohol misusers followed serially from detoxification over 6 months. Poor assay performance could not be attributed to chronic inflammation or iron status. There was evidence that some false positive results reflected changes in the transferrin isoform profile on HPLC which differed from changes associated with alcohol misuse. Conclusion: CDT was unsatisfactory using commercial kits and when used alone. In combination with other laboratory markers of alcohol misuse improved overall performance for both screening and monitoring. Further developments are needed in order to maximise the performance of the commercial techniques for assaying serum CDT.

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