TY - BOOK
T1 - The Role of Carbohydrate Deficient Transferrin as an alternative to Gamma Glutamyl Transferase as a marker of continuous drinking in High Risk Drivers
AU - Wolff, Kim
AU - Gross, Samantha
AU - Marshall, E. Jane
AU - Walsham, Natalie
AU - Keaney, Francis
AU - Sherwood, Roy
PY - 2010
Y1 - 2010
N2 - Biomarkers are specifically used to aid assessment as part of the process leading to a decision to reinstate driving entitlement for those drink drivers who are qualified as high-risk offenders. The biomarkers currently used (MCV, AST, ALT, and GGT) to aid the assessment of continuous (harmful or dependent) drinking in High Risk Offenders (HRO) scheme were compared with %CDT in this study. We assessed these measures in three different drinking populations, (a) alcohol dependent inpatient population; (b) community-based outpatient population with history of harmful alcohol use/dependence and; (c) non-treatment social drinkers. A fourth group was also assessed specifically in order to control for confounders, (d) obese, diabetic and those with liver disease from specialist medical hospital populations.
In our 358 (male 53 %), mainly White British (79%) subjects with a mean age of 46 years, less than half smoked cigarettes (44 %) and 18% reported use of cannabis. The alcohol treatment subjects were shown to have drank alcohol on significantly more days (2 = 310.3, p < 0.001) and consumed significantly more units of alcohol on an average day (2 = 287.7, p <0.001) in the preceding month than either the special hospital subjects or the social drinkers.
The biomarkers (MCV, AST, ALT, GGT and %CDT) were able to distinguish between harmful and dependent drinkers and social drinkers when these populations were combined. %CDT retained good diagnostic power (0.88%) when subjects with a formal alcohol use disorder were combined with subjects being treated for obesity, diabetes and non-alcoholic liver disease (the special hospital groups) compared with GGT. The positive predictive power of the biomarkers varied when used to identify continuous drinking in our whole sample population. %CDT (PPV = 0.91) and MCV (PPV = 0.83) demonstrated better diagnostic power than GGT (PPV = 0.63). Overall the sensitivity and specificity of %CDT was superior to GGT as a biomarker of continuous alcohol consumption as shown by receiver operating characteristics (ROC curves). Our findings demonstrated diagnostic efficiency for %CDT (AUC 0.91) superior to GGT (AUC 0.80) for the identification of continuous (harmful or dependent) drinking in a sub-population representative of whose who seek re-granting of driver licenses.
Therefore in populations where confounders for common biomarkers of alcohol consumption are present %CDT is known to be superior and ideally, should be the preferred tool. As a minimum requirement, %CDT measurement should normally be undertaken in subjects who are obese, have diabetes and/or chronic liver disease (whether alcohol related or otherwise).
AB - Biomarkers are specifically used to aid assessment as part of the process leading to a decision to reinstate driving entitlement for those drink drivers who are qualified as high-risk offenders. The biomarkers currently used (MCV, AST, ALT, and GGT) to aid the assessment of continuous (harmful or dependent) drinking in High Risk Offenders (HRO) scheme were compared with %CDT in this study. We assessed these measures in three different drinking populations, (a) alcohol dependent inpatient population; (b) community-based outpatient population with history of harmful alcohol use/dependence and; (c) non-treatment social drinkers. A fourth group was also assessed specifically in order to control for confounders, (d) obese, diabetic and those with liver disease from specialist medical hospital populations.
In our 358 (male 53 %), mainly White British (79%) subjects with a mean age of 46 years, less than half smoked cigarettes (44 %) and 18% reported use of cannabis. The alcohol treatment subjects were shown to have drank alcohol on significantly more days (2 = 310.3, p < 0.001) and consumed significantly more units of alcohol on an average day (2 = 287.7, p <0.001) in the preceding month than either the special hospital subjects or the social drinkers.
The biomarkers (MCV, AST, ALT, GGT and %CDT) were able to distinguish between harmful and dependent drinkers and social drinkers when these populations were combined. %CDT retained good diagnostic power (0.88%) when subjects with a formal alcohol use disorder were combined with subjects being treated for obesity, diabetes and non-alcoholic liver disease (the special hospital groups) compared with GGT. The positive predictive power of the biomarkers varied when used to identify continuous drinking in our whole sample population. %CDT (PPV = 0.91) and MCV (PPV = 0.83) demonstrated better diagnostic power than GGT (PPV = 0.63). Overall the sensitivity and specificity of %CDT was superior to GGT as a biomarker of continuous alcohol consumption as shown by receiver operating characteristics (ROC curves). Our findings demonstrated diagnostic efficiency for %CDT (AUC 0.91) superior to GGT (AUC 0.80) for the identification of continuous (harmful or dependent) drinking in a sub-population representative of whose who seek re-granting of driver licenses.
Therefore in populations where confounders for common biomarkers of alcohol consumption are present %CDT is known to be superior and ideally, should be the preferred tool. As a minimum requirement, %CDT measurement should normally be undertaken in subjects who are obese, have diabetes and/or chronic liver disease (whether alcohol related or otherwise).
KW - CARBOHYDRATE-DEFICIENT TRANSFERRIN
KW - Alcohol use disorder
KW - drink-driving
M3 - Book
SN - 9781848640016
BT - The Role of Carbohydrate Deficient Transferrin as an alternative to Gamma Glutamyl Transferase as a marker of continuous drinking in High Risk Drivers
PB - Department for Transport
CY - London
ER -
