ABSTRACT
OBJECTIVE: Conventional tests for alcoholism fail to confirm hazardous and harmful alcohol use (HHAU) accurately and objectively. We validated a Bayesian Alcoholism Test (BAT) for confirming the diagnosis of HHAU. STUDY DESIGN AND SETTING: BAT is based on studies on the prevalence of HHAU and other diseases causing similar abnormalities, and on conditional probabilities of these disorders and associated biochemical markers and clinical signs. BAT was compared to carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in treatment-seeking alcoholics, non-treatment-seeking heavy drinkers, and controls. Main outcome measures were test sensitivity and specificity, likelihood ratios, and receiver-operating characteristic (ROC) curves. RESULTS: Comparing alcoholics and controls, sensitivity of BAT (94%) was significantly higher than CDT (63%) and GGT (73%). The area under the ROC curve for BAT (.989) was significantly higher than the area under the curve for CDT (.909) and area under the curve for GGT (.902). Using pooled data of all 182 subjects included in the study, the amount of drinking had a significant better correlation coefficient with BAT (.795) than with CDT (.657), and GGT (.604). CONCLUSION: BAT has better diagnostic properties than CDT and GGT for confirming HHAU.
Subject(s)
Alcoholism/diagnosis , Adult , Aged , Alanine Transaminase/blood , Biomarkers/blood , Epidemiologic Methods , Ethanol/administration & dosage , Female , Humans , Liver Diseases, Alcoholic/diagnosis , Male , Middle Aged , Patient Acceptance of Health Care , Transferrin/analogs & derivatives , Transferrin/analysis , gamma-Glutamyltransferase/bloodABSTRACT
BACKGROUND: We attempted to determine whether including trisialo-Fe2-transferrin in carbohydrate-deficient transferrin (CDT) affects the diagnostic accuracy of CDT as a marker of chronic excessive alcohol intake. MATERIAL/METHODS: The criterion standard tests for the diagnosis of alcoholism and alcohol intake were the Composite International Diagnostic Interview (CIDI) and the Timeline-Followback (TLFB). The study groups (alcohol intake in each of the last 4 weeks before blood sampling) were comprised of 56 controls (< or = 280 g/week, no alcoholism), 54 hazardous drinkers (>280 g/week, no alcoholism), 63 alcoholics (>280 g/week, alcoholism diagnosis). CDT analysis was performed with %CDTri-TIA, which includes about 50% of trisialo-Fe2-transferrin in CDT, and ChronAlcoI.D, which excludes this transferrin isoform from CDT. RESULTS: Depending on the cut-offs for the CDT/transferrin ratio (upper or lower limit of the test-specific borderlines) and on the patient group, the diagnostic sensitivity was 28.1%-72.3% for %CDTri-TIA, as opposed to 50.0%-82.5% for ChronAlcoI.D. The diagnostic accuracy was 62.8%-78.5% for %CDTri-TIA and 71.8%-86.6% for ChronAlcoI.D. The latter test consistently showed higher diagnostic sensitivity and accuracy than %CDTri-TIA. The diagnostic specificity was 85.7%-98.2% for %CDTri-TIA and 91.1%-92.2% for ChronAlcoI.D. The areas under the ROC curve were 0.810%-0.885 for %CDTri-TIA and 0.867%-0.896 for ChronAlcoI.D. CONCLUSIONS: The present study and data from the literature indicate that including parts of trisialo-Fe2-transferrin by the %CDTri-TIA test significantly reduces the diagnostic sensitivity and thus accuracy of CDT as a marker of chronic excessive alcohol use.
