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The Role of the Clinical Laboratory in Nutritional Assessment
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
The two primary biomarkers of alcoholism are gamma glutamyl transferase (GGT) and carbohydrate-deficient transferrin (CDT).32 Phosphatidylethanol is another biomarker of regular alcohol consumption. In a 1989 study, 19 of 22 (86%) self-reported alcoholics had elevated CDT levels, versus none of 47 patients with non-alcoholic liver disease.33 In a more current study, of the various biomarkers for alcoholism, CDT had the highest area under the curve (0.77), followed by GGT (0.68).34 The percentage of excessive drinkers with aspartate aminotransferase:alanine aminotransferase ratio (AST:ALT) >2 was only 2%, a very low sensitivity. CDT typically normalizes within weeks of abstinence. Importantly, there are other causes of elevated CDT levels, including congenital disorders of glycosylation (e.g., hereditary fructosamine and galactosemia) and other genetic and nongenetic causes of liver disease.
Fundamentals of Receiver Operating Characteristic Curve Analyses
Published in Albert Vexler, Alan D. Hutson, Xiwei Chen, Statistical Testing Strategies in the Health Sciences, 2017
Albert Vexler, Alan D. Hutson, Xiwei Chen
In order to examine methods for combining quantitative results for serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and aspartate aminotransferase (AST), and refining these by inclusion of patient characteristics, Chen et al. (2003b) developed clinical rules for combining the results based on the data from 1684 subjects, recruited from the general population, abstainer groups, and alcohol treatment centers (participants in the five-nation WHO/ISBRA study of biological markers of alcohol use). It was concluded that combining biochemical markers enhances detection of problem drinking in men but not in women. Information on clinical variables increases the ability to correctly detect problem drinking.
Systemic illnesses (diabetes mellitus, sarcoidosis, alcoholism, and porphyrias)
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Stephanie Kielb, Laurie Bachrach, Nancy Rios
Unfortunately, identification of alcohol abuse is often difficult because it involves elements of denial and lack of rationalization. Often, information from relatives and surveys can be of help. Biological confirmation via laboratory and physical examinations may also help expose the problem. Several abnormalities are seen in laboratory analysis such as, elevated aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), carbohydrate-deficient transferrin (CDT), and erythrocyte mean corpuscular volume (MCV). A high AST/ALT ratio, elevated GGT and CDT are virtually 80% specific for the diagnosis.54 Clinical symptoms can develop acutely within days or progress increasingly over weeks. During the early stage of nutritional deficiency patients experience fatigue, muscle cramping, and irritability. If nutritional deficiency is prolonged for an extended period, signs of neuropathy begin to appear. First, patients experience distal sensory loss accompanied with weakness in both hands and feet, followed by cramping and aching particularly of the lower extremities associated with mild sensory loss and dysesthesias.
Consumption outcomes in clinical trials of alcohol use disorder treatment: Consideration of standard drink misestimation
Published in The American Journal of Drug and Alcohol Abuse, 2019
Megan Kirouac, Eric Kruger, Adam D. Wilson, Kevin A. Hallgren, Katie Witkiewitz
The COMBINE study used a rigorous methodology for accurately collecting drinking data. Trained research assistants administered the Form 90, a calendar-based method that asks participants about their drinking in the 90 days preceding the assessment (18). Memory cues were used to facilitate accurate recollection and visual aids of drink containers were provided with active probing about drink sizes in effort to obtain accurate drink size estimates. Research assistants collected data on brands and types of beverages and computed the number of standard drinks rather than relying on participant calculations. The COMBINE study also used biochemical verification for participant drinking using % Carbohydrate Deficient Transferrin (%CDT; 16). For the purposes of our simulation, we considered the methodology used in the COMBINE study to be the gold standard method for accurately assessing drinking quantities in alcohol clinical trials. We therefore used a simulation design with the COMBINE data reflecting the “true” amount of alcohol consumption, which we then degraded by incorporating increasing levels of drink size misestimation.
Long-term survival and predictors of relapse and survival after liver transplantation for alcoholic liver disease
Published in Scandinavian Journal of Gastroenterology, 2018
Christine Lindenger, Maria Castedal, Andreas Schult, Fredrik Åberg
Patients with documented lack of alcohol abstinence post-LT were, in line with current recommendations [5], categorized into alcohol ‘slip’ (defined as sporadic drinking events followed by reestablishment of abstinence) and relapse (defined as repeated episodes of excessive or harmful drinking; specifically, consuming 4–5 or more drinks in a day or at least 1 drink ≥4 d in succession). Information was obtained from medical records, where alcohol use was revealed by interview of the patient and relatives, clinical follow-up, biochemical markers of alcohol use and possible alcohol-related admissions. In addition, patients’ physicians at the home-district clinics were contacted by mail and asked to fill in a structured form (Supplemental material) to provide additional information regarding alcohol use after LT, among other things. The response rate from physicians was 100%. Alcohol use is routinely assessed in the follow-up of patients transplanted due to ALD. Blood phosphatidylethanol (PEth) measurements to detect alcohol use have become routine after year 2012 [22,23], but has been inconsistently used since 2010. Before 2012 carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase were used as biochemical markers for alcohol use and as needed on an individual basis serum alcohol measurements and/or breath alcohol tests were performed.
Mean platelet volume and mean platelet volume/platelet count ratio in patients with chronic alcohol consumption
Published in Platelets, 2015
Sun Young Cho, Hee Joo Lee, Jong Woo Kim, Tae Sung Park
Mean platelet volume (MPV) is a parameter generated by fully automated blood count analyzers as a part of routine complete blood count (CBC), and a useful laboratory index for estimating platelet function and activation [1–3]. In the aspect of alcohol effects on MPV, MPV has been investigated in alcohol-associated liver disease such as alcoholic fatty liver disease and alcoholic liver cirrhosis and in vivo condition, respectively [4, 5]. However, data which directly analyzed MPV and laboratory marker for alcohol consumption were very rare, although increased mean corpuscular erythrocyte volume (MCV) is a commonly used CBC index in patients with chronic alcoholics. Therefore, we planned to study this platelet index in patients with chronic alcohol abuse to investigate whether chronic alcohol consumption can influence to MPV. We used carbohydrate-deficient transferrin (CDT) test, the sum of a- and disialotransferrin, to identify patients with chronic alcohol consumption, which is considered the most efficient routine biological marker of alcohol abuse [6, 7].