SENSITIVITY OF CARBOHYDRATE-DEFICIENT TRANSFERRIN (CDT) IN RELATION TO AGE AND DURATION OF ABSTINENCE

Alcohol & Alcoholism Vol. 33, No. 2, pp. 164-167, 1998 SENSITIVITY OF CARBOHYDRATE-DEFICIENT TRANSFERRIN (CDT) IN RELATION TO AGE AND DURATION OF ABSTINENCE M. W. AGELINK*, A. DIRKES-KERSTING 1 , T. ZEIT, R. BERTLING, R. MALESSA2 and E. KLIESER Department of Psychiatry, University of Bochum, Evangl. Hospital Gelsenkirchen, Munckelstr 27, D-45879 Gelsenkirchen. 'Hygiene-Institute of the Ruhrgebiet, Gelsenkirchen and department of Neurology, University of Jena, Germany (Received 14 April 1997; in revised form 29 August 1997, accepted 27 October 1997) Abstract — Carbohydrate-deficient transferrin (CDT) serum concentrations were prospectively determined in 162 subjects (alcoholics n = 62, controls n = 1 0 0 ) using three different methods of detection (IEF, CDTect™, Axis%CDT™). Repeated testing in alcoholics after 3 and 5 days of abstinence demonstrated a significantly higher sensitivity of CDT in patients above 40 years of age compared to younger patients. INTRODUCTION In recent years, carbohydrate-deficient transferrin (CDT) has been recognized as a reliable state marker of high alcohol consumption (Stibler, 1991). Recent data suggest CDT to be helpful in monitoring alcoholics during periods of alcohol abstinence in order to detect relapses (Helander et al., 1996; Schmidt et al., 1997). Whereas the high specificity of CDT is widely accepted (Stibler, 1991), its sensitivity is still a contentious issue; the data range from 22% to 83% (Nystrom et al., 1992; Spies et al., 1995). To investigate the influence of age and duration of abstinence on CDT sensitivity, we prospectively determined the serum CDT concentrations in 62 alcohol-dependent in-patients on the first, third and fifth days of abstinence and compared the sensitivities of CDT in different age subgroups. SUBJECTS AND METHODS Sixty-two alcoholics diagnosed according to DSM-HJ-R criteria (American Psychiatric Association, 1987) (patients with polytoxico-mania were excluded), who were admitted to our hospital and asked to withdraw from alcohol, underwent a *Author to whom correspondence should be addressed. detailed addiction history including the Munich Alcoholism Test (MALT) questionnaire (Feuerlein et al., 1977) and information on drinking behaviour (frequency and extent of daily alcohol intake). All had a daily alcohol consumption of more than 80 g over the previous 3 months (range: 85-210g/day). Routine laboratory testing on the first, third, and fifth days after admission as well as a general medical and neurological examination were performed in all cases. None of the patients had clinical evidence of liver cirrhosis or alcohol related polyneuropathy. For further analysis, patients were divided into two subgroups according to their age: group I <40 years (n = 20, median 36 years, range: 2 8 ^ 0 years); group II >40 years (n = 42, median 50 years, range: 41-69 years). Fasting blood samples were taken from the cubital vein after minimal stasis between 07:30 and 08:30. Determinations of CDT serum concentrations were performed using three different techniques: (1) isoelectric focusing (IEF) followed by immunofixation applied to the Pharmacia Phast System™ according to the method of van Noort and van Eijk (1992) with a cut-off of 20U/1 for men and 24 U/l for women; (2) anion-exchange chromatography followed by double antibody radioimmunoassay (Kabi Pharmacia Diagnostics, CDTect™) with a cut-off of 20 U/l for men and 26 U/l for women; (3) anion-exchange chromato164 © 1998 Medical Council on Alcoholism AGE, ABSTINENCE DURATION AND CDT SENSITIVITY 165 Table 1. Sensitivity of carbohydrate-deficient transferrin (CDT) during a 5-day period of alcohol abstinence in 62 alcoholics of different age subgroups Frequency of CDT values above the cut-off level (n) and sensitivity of CDT («• Groups and gender CDT determination: Day of abstinence: Group I (<40 years) n = 20 Male (n = 13) Female {n = 7) Group II (>40 years) « = 42 Male (n = 25) Female (n = 17) CDTect™ IEF Axis%CDTAssay™ 1st 3rd 5th 1st 3rd 5th 1st 3rd 5th 11 (55) 8 (62) 3 (43) 8(40) 6(46) 2(29) 6(30) 5(38) 1 (14) 10 (50) 7(54) 3(43) 8(40) 6(46) 2(29) 6(30) 4(31) 2(29) 10 (50) 7(54) 3(43) 7(35) 5(38) 2(29) 6(30) 4(31) 2(29) 34 (81) 21 (84) 13 (76) 33 (79) 21 (84) 12(71) 27 (64) 17 (68) 10 (59) 33 (79) 20 (80) 13 (76) 33 (79) 20 (80) 13 (76) 27(64) 17 (68) 10 (59) 31 (74) 20 (80) 11 (65) 27(64) 25 (60) 17(64) 16(64) 10 (59) 9(53) Abbreviation: IEF, iso-electric focusing. graphy of transferrin antibody complexes (Axis Biochemicals AS, Axis%CDTAssay™) with a cutoff of 2.5% for both sexes. Cut-off levels for all individual methods were committed to the 95th percentile of CDT data obtained from 100 well-matched healthy volunteers (mean age 36.7 years, male/female ratio was 61/39) with a daily alcohol intake of less than 20 g. For comparison of numeric variables (categorical variables) across groups, the MannWhitney test (yj or Fisher's test) were used (significance level P < 0.05). RESULTS Between the subgroups created here (groups I and II), no significant differences emerged in relation to the following alcohol-related variables: mean (± SD) MALT total score (28.9 ± 6.0 vs 29.5 ± 7.4), mean daily alcohol consumption (137.8 ± 38.0 vs 141.4 ± 42.7 g/day) and mean duration of the last period of abuse (24.6 ± 13.0 vs 21.5 ± 11.4 weeks). As expected, patients in group II had a significantly longer history of alcohol dependency compared to younger patients (9.2 ±3.1 vs 4.1 ± 3.5 years, Mann-Whitney test P < 0.05). Table 1 compares the CDT sensitivity of each individual method concerning age and gender differences. At all times of examination, we found a higher sensitivity of CDT in men compared to women. In male as well as female patients, the sensitivity of CDT in detecting alcoholism was obviously higher in subjects over 40 years of age compared to younger subjects. In both groups, the sensitivity of CDT decreased as abstinence continued. On the third and fifth days of abstinence, there was a significantly higher sensitivity of CDT in group II compared to group I (P < 0.05, x2-test for a 2 x 2 plan; group I vs n, absolute frequency of CDT values above vs below the cut-off level). Interestingly, measuring CDT with the three different techniques (at least one value above the cut-off level) led to a substantial increase of CDT sensitivity only for patients over the age of 40 years. In that group, we found a sensitivity of 81% even after 5 days of abstinence (the maximum sensitivity obtained for any of these procedures alone was only 64%), whereas in group I, there was a 5% increase of CDT sensitivity only (fifth day: 35%). DISCUSSION Our data demonstrate a significantly higher sensitivity of CDT as a marker of chronic alcohol consumption in alcoholics over 40 years of age, compared to younger subjects. This may reflect that younger individuals have a shorter history of heavy alcohol consumption or that they may recover more quickly a (...truncated)