%CDT Glutamyl transferase and MCV

[Guest guest]

these tests vindicated me when I had false positive EtG... INFLUENCE OF AGE, ALCOHOL CONSUMPTION AND ABSTINENCE ON THE SENSITIVITY OF CARBOHYDRATE-DEFICIENT TRANSFERRIN, -GLUTAMYLTRANSFERASE AND MEAN CORPUSCULAR VOLUME Götz Mundle*, Klaus Ackermann, Jörg Munkes, a Steinle and Karl Mann University of Tübingen, Department of Psychiatry, Addiction Research Centre, Osianderstrasse 24, 72076 Tübingen, Germany Received 18 September 1998; in revised form 25 January 1999; accepted 16 March 1999 ABSTRACT TOPFOOTNOTESABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES Duration of abstinence before blood test, alcohol consumption and age was examined in 177 male alcohol-dependent patients as factors influencing serum carbohydrate-deficient transferrin (CDT), serum -glutamyltransferase (GGT) and mean corpuscular volume (MCV). The strongest influence on all markers was the factor ‘duration of abstinence before blood test’. In patients who had been abstinent for >4 days before the blood test, the markers had low sensitivities (GGT, 33%;

CDT, 14%; MCV, 42%), whereas in patients with 4 days of abstinence the markers had reasonably good sensitivities (GGT, 72%; CDT, 56%; MCV, 48%). GGT was more sensitive than CDT (P < 0.05) and MCV (P < 0.001). The combined use of CDT and GGT had sensitivity of over 90%. Mean alcohol consumption in the 30 days prior to the blood test had a significant effect on CDT and GGT, but not on MCV. Age did not have a clear effect on CDT and GGT. For MCV, a significant and linear increase with age was shown. We conclude that GGT is the most sensitive of these three markers. Using GGT and CDT combined, sensitivity can be enhanced to over 90%. The period of abstinence before the blood test has a strong influence on CDT and GGT. If a longer period of

abstinence is suspected, MCV should also be measured, in order to detect evidence of earlier heavy drinking. INTRODUCTION TOPFOOTNOTESABSTRACTINTRODUCTIONPATIENTS AND METHODSRESULTSDISCUSSIONACKNOWLEDGEMENTSREFERENCES Excessive alcohol consumption and alcoholism are widely observed risk factors for health damage and social problems. Early identification of excessive alcohol consumption and alcoholism could improve the possibility of early treatment and reduce health damage and health care costs. Although self-report is in general a valid and important diagnostic instrument

(Maisto and O'Farrell, 1985; Babor et al., 1989; Rosman et al., 1992; Mundle et al., 1996), more objective and effective screening instruments, such as biological markers, are

needed. Traditional markers are the membrane-bound liver enzyme -glutamyltransferase (GGT) and the mean corpuscular volume (MCV), an index of red blood cell size (Conigrave et al., 1995). The difficulty of diagnostic accuracy has been a limiting factor, although these markers are widely available. The most effective marker has been GGT with a sensitivity of about 40–60% and a specificity of about 80% (Mihas and Tavassoli, 1992). A new

marker for high alcohol consumption and alcoholism is carbohydrate-deficient transferrin (CDT). Early studies on CDT were promising and suggested high sensitivity and high specificity (Stibler, 1991). Studies comparing the diagnostic value of CDT with other biological markers usually suggested the superiority of CDT, particularly because of its specificity (Litten et al., 1995; Sillanaukee, 1996). Recent studies comparing the sensitivity of GGT and CDT, however, have shown a similar or even higher sensitivity for GGT in detecting heavy alcohol consumption and alcoholism (Helander and Tabakoff, 1997; Huseby et al., 1997; Yeastedt et al., 1998). Most studies have

suggested that GGT and CDT appear to be independent and may therefore compliment each other. Their combined use is reported to increase diagnostic sensitivity with little loss of specificity (Litten et al., 1995; Sillanaukee, 1996; Yeastedt et al., 1998). Factors influencing biological markers are duration of abstinence, age and alcohol

consumption. The duration of abstinence before blood testing can cause differences in study results, especially for CDT, which has a relatively short half-life of 15 days (Behrens et al., 1988; Stibler et al., 1988). Nevertheless, the time since the last drink is included in only a few studies. General conclusions from study results are therefore limited in scope (Litten et al., 1995). The effects of age have also been reported in only a few studies. These indicate that GGT and MCV increase with age (Whitfield et al., 1978; Sillanaukee et al., 1998). Yersin et al. (1995) observed an increase in sensitivity in older patients from 56 to 74% for GGT and an increase from 17 to 39% for MCV. Daeppen et al. (1998) found a 64% average increase in GGT over a 15-year period in alcohol-drinking, but non-alcoholic,

males, independent of alcohol consumption. The effect of age on CDT is inconsistent. Nystrom et al. (1992) recommended serum CDT for detecting early heavy drinking in young students, although the sensitivity was relatively low. Yersin et al. (1995) and Huseby et al. (1997) found that CDT values decreased with age; test results were highest in younger patients. Agelink et al. (1998) found that CDT was more sensitive in patients over 40 years of age than in younger patients. Conigrave et al. (1995) concluded that the sensitivity of all three markers is lower for hazardous consumption than for alcohol dependence: 20–60% vs 60–90% for CDT and GGT, and 20–30% vs 40–50% for MCV. The aims of this study were to compare the sensitivities of CDT, GGT and MCV in a large clinical sample of male

alcohol-dependent patients entering a 6-week in-patient treatment programme (Mann and Batra, 1993) and to analyse the factors influencing the test results of all three markers. doetta5555 <doetta5555@...> wrote: I just talked to my probation

monitor and she said I had another positive drug screen on 5/15/08 that is significantly higher than it's ever been. I can't find out the number until I talk to the MRO Dr. Brown. I don't know what good that will do. She said they will be going for revocation. I have already been suspended from working since last July. So far my place of employment hasn't fired me but I doubt after a year I'll still have a job. My disability runs out this month. I doubt I can get unemployment because I haven't been fired. I haven't drank and here I thought I was doing so well, then I get this news. It's enough to drive you crazy! I know, my sponsor knows and my higher power knows how well I am doing in my recovery program but it sure does beat you down.I will celebrate 2 yrs.in July. Is there any other test to recommend that says I haven't drank? I don't think a hair test would. I can see my legal fees going up and up and up. I will need

to find a new career. I am just a bit overwhelmed right now. Thanks for listening, Diane