Carbohydrate Deficient Transferrin (CDT) as a Biomarker to Assess Drinking in High-Risk Drink Drivers

TY - JOUR

T1 - Carbohydrate Deficient Transferrin (CDT) as a Biomarker to Assess Drinking in High-Risk Drink Drivers

AU - Wolff, Kim

AU - Gross, Samantha

AU - Marshall, E J

AU - Walsham, N E

AU - Robson, N

AU - Keaney , F

AU - Sherwood, R A

PY - 2019

Y1 - 2019

N2 - The diagnostic value of biomarkers of alcohol consumption differs dependent upon the population under investigation. Inthis regard, clarification is needed in the choice of biomarker used to aid the medical assessor support a return to drivingafter a drink-driving offence. Blood samples were collected (5mL serum and 3.5mL whole blood EDTA) to measurecarbohydrate deficient transferrin (%CDT) as a biomarker of alcohol consumption compared to gamma glutamyltransferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), and alanine aminotransferase(ALT). Subjects were recruited to reflect the characteristics of a high-risk drink driving community in the UnitedKingdom. The ICD-10 or the Alcohol Use Disorders Identification Test (AUDIT) was used to diagnose an alcohol usedisorder. 358 participants were recruited: 165 seeking treatment for harmful use or alcohol dependence: 142 seekingtreatment for liver, diabetes or obesity problems: and 51 social drinkers (controls). %CDT was able to identify drinkingindicative of excessive alcohol intake significantly more accurately than other biomarkers (Z=-9.017, p<0.001). Thepositive predictive value for %CDT (+ve PPV 0.88) demonstrated the best diagnostic power when tested compared toGGT (+ve PPV 0.69), inclusive of confounders. When the whole study population was taken into account the sensitivityand specificity of %CDT for the diagnosis of excessive alcohol use remained unchanged (area under curve 0.91) whereasthe diagnostic power of GGT was poorer (area under curve 0.80). %CDT was superior to GGT as a marker of excessivealcohol consumption (continuous drinking) when tested against a population that included diabetic, obese and patientswith non-alcoholic liver disease: a data set which bests mimics those seen in the high-risk drink driving population

AB - The diagnostic value of biomarkers of alcohol consumption differs dependent upon the population under investigation. Inthis regard, clarification is needed in the choice of biomarker used to aid the medical assessor support a return to drivingafter a drink-driving offence. Blood samples were collected (5mL serum and 3.5mL whole blood EDTA) to measurecarbohydrate deficient transferrin (%CDT) as a biomarker of alcohol consumption compared to gamma glutamyltransferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), and alanine aminotransferase(ALT). Subjects were recruited to reflect the characteristics of a high-risk drink driving community in the UnitedKingdom. The ICD-10 or the Alcohol Use Disorders Identification Test (AUDIT) was used to diagnose an alcohol usedisorder. 358 participants were recruited: 165 seeking treatment for harmful use or alcohol dependence: 142 seekingtreatment for liver, diabetes or obesity problems: and 51 social drinkers (controls). %CDT was able to identify drinkingindicative of excessive alcohol intake significantly more accurately than other biomarkers (Z=-9.017, p<0.001). Thepositive predictive value for %CDT (+ve PPV 0.88) demonstrated the best diagnostic power when tested compared toGGT (+ve PPV 0.69), inclusive of confounders. When the whole study population was taken into account the sensitivityand specificity of %CDT for the diagnosis of excessive alcohol use remained unchanged (area under curve 0.91) whereasthe diagnostic power of GGT was poorer (area under curve 0.80). %CDT was superior to GGT as a marker of excessivealcohol consumption (continuous drinking) when tested against a population that included diabetic, obese and patientswith non-alcoholic liver disease: a data set which bests mimics those seen in the high-risk drink driving population

U2 - 10.23880/act-16000160

DO - 10.23880/act-16000160

M3 - Article

SN - 2577-4328

VL - 4

SP - 1

EP - 11

JO - Advances in Clinical Toxicology

JF - Advances in Clinical Toxicology

IS - 3

ER -