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Carbohydrate deficient transferrin is not a useful marker for the detection of chronic alcohol abuse
Author(s) -
◗ Schmitt,
Stieber,
Jüngst,
Bilzer,
Wächtler,
Heberger,
Seidel
Publication year - 1999
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.1999.00557.x
Subject(s) - medicine , biochemistry , library science , computer science
In the following remarks we reply to the points of criticism raised by J. Allen et al. [1], Axis Biochemicals; one of the companies producing CDT test kits. The term ‘unselected’ was used to underline that our trial was performed on occasionally recruited patients of various medical departments without preselection for diseases or drinking behaviour. With regard to the question of alcohol intake ‘yes or no’; on the basis of our results we and others [2–5] do not believe that CDT has a higher diagnostic performance than do other laboratory markers, especially if the clinical background of the person to be tested cannot be, or is not, carefully investigated and taken into consideration. We agree that it will always be difficult to obtain an absolute objective status about alcohol drinking behaviour, but the problem related to the high number of false negative CDT-test results cannot be explained with a wrong or weak anamnesis. If Allen et al. are correct in their belief that CDT serum levels must decrease after one week of alcohol abstinence then the clinical utility of CDT must be questioned, as only two out of 14 follow-up investigations showed the expected kinetics. The aim of our study was to evaluate whether CDT testing does fulfil its claim to be a diagnostic tool for chronic alcohol abuse. The combination of CDT and GGT, as suggested, to raise the diagnostic specificity is meaningless because it is logical that a non-specific parameter cannot be improved by combining it with another non-specific laboratory test that is limited by similar or identical influencing factors. No doubt, CDT sensitivity is not equal or beyond that of GGT, even if the specificity is higher, but it is by far too insufficient for the diagnosis of chronic alcohol abuse. According to our experience this also holds true for other test principles when taking the percentage of total serum transferrin into consideration [6]. Thus, we and others [7,8] are convinced that the measurement of CDT cannot improve good clinical practice, and should not be the basis for judgement in forensic medicine.