A DiMartini1, N Day, T Lane, A T Beisler, M A Dew, R Anton. 1. University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinics, Pittsburgh, Pennsylvania 15213, USA. dimartiniaf@msx.upmc.edu
Abstract
BACKGROUND: Carbohydrate deficient transferrin (CDT), a biochemical marker of chronic alcohol consumption, is used by researchers and clinicians alike in a variety of populations. Levels of CDT may be affected by certain types of medical illnesses and conditions. Thus the interpretation of CDT results may need to be carefully examined in these populations. Because CDT is synthesized, glycosylated, and secreted by the liver, the use of CDT values in patients with liver disease has been an area of focused interest. METHODS: We evaluated the CDT values of 79 abstaining patients with end-stage liver disease. These patients were recruited from a liver transplant clinic while they were listed and waiting for transplantation. Patients were determined to be abstaining both by interview and by random blood alcohol levels in those with a diagnosis of alcoholic liver disease. The severity of the liver disease was categorized by the Child-Pugh score. Correlations were determined between CDT values and liver enzymes, and Child-Pugh scores and liver diagnosis. RESULTS: Nearly 50% of the patients had a CDT value of 2.6% or above, indicating a clinically positive value. There were strong correlations between CDT and a number of biochemical and physical variables, most importantly the Child-Pugh score (r = 0.52, p = 0.000). Specific liver diseases were not associated with absolute CDT values. However, patients with hepatitis C (HCV) had a significantly higher chance of having a clinically positive CDT compared with patients with other types of liver diseases. CONCLUSIONS: These results suggest that an elevated CDT value may not accurately represent alcohol consumption in patients with advanced liver disease. In fact, in such patients, the CDT may become a marker for the degree of liver impairment in alcoholic and nonalcoholic liver disease. CDT values should be viewed with caution in any patient with liver disease especially when the degree of cirrhosis reaches a Child-Pugh score of C (total score of 10 or above).
BACKGROUND:Carbohydrate deficient transferrin (CDT), a biochemical marker of chronic alcohol consumption, is used by researchers and clinicians alike in a variety of populations. Levels of CDT may be affected by certain types of medical illnesses and conditions. Thus the interpretation of CDT results may need to be carefully examined in these populations. Because CDT is synthesized, glycosylated, and secreted by the liver, the use of CDT values in patients with liver disease has been an area of focused interest. METHODS: We evaluated the CDT values of 79 abstaining patients with end-stage liver disease. These patients were recruited from a liver transplant clinic while they were listed and waiting for transplantation. Patients were determined to be abstaining both by interview and by random blood alcohol levels in those with a diagnosis of alcoholic liver disease. The severity of the liver disease was categorized by the Child-Pugh score. Correlations were determined between CDT values and liver enzymes, and Child-Pugh scores and liver diagnosis. RESULTS: Nearly 50% of the patients had a CDT value of 2.6% or above, indicating a clinically positive value. There were strong correlations between CDT and a number of biochemical and physical variables, most importantly the Child-Pugh score (r = 0.52, p = 0.000). Specific liver diseases were not associated with absolute CDT values. However, patients with hepatitis C (HCV) had a significantly higher chance of having a clinically positive CDT compared with patients with other types of liver diseases. CONCLUSIONS: These results suggest that an elevated CDT value may not accurately represent alcohol consumption in patients with advanced liver disease. In fact, in such patients, the CDT may become a marker for the degree of liver impairment in alcoholic and nonalcoholic liver disease. CDT values should be viewed with caution in any patient with liver disease especially when the degree of cirrhosis reaches a Child-Pugh score of C (total score of 10 or above).
Authors: A L Trout; R Prasad; D Coffin; A DiMartini; T Lane; C Blessum; N Khatter; J P Landers Journal: Electrophoresis Date: 2000-07 Impact factor: 3.535
Authors: T M De Feo; S Fargion; L Duca; M Mattioli; M D Cappellini; M Sampietro; B M Cesana; G Fiorelli Journal: Hepatology Date: 1999-03 Impact factor: 17.425
Authors: H Bell; C Tallaksen; T Sjåheim; R Weberg; N Raknerud; H Orjasaeter; K Try; E Haug Journal: Alcohol Clin Exp Res Date: 1993-04 Impact factor: 3.455
Authors: S H Caldwell; J W Halliday; L M Fletcher; M Kulaga; T L Murphy; X Li; R C Dickson; P K Kiyasu; P L Featherston; K Sosnowski Journal: J Gastroenterol Hepatol Date: 1995 Mar-Apr Impact factor: 4.029
Authors: John B Whitfield; Steven Masson; Suthat Liangpunsakul; Jessica Hyman; Sebastian Mueller; Guruprasad Aithal; Florian Eyer; Dermot Gleeson; Andrew Thompson; Felix Stickel; Michael Soyka; Ann K Daly; Heather J Cordell; Tiebing Liang; Tatiana Foroud; Lawrence Lumeng; Munir Pirmohamed; Bertrand Nalpas; Camille Bence; Jean-Marc Jacquet; Alexandre Louvet; Romain Moirand; Pierre Nahon; Sylvie Naveau; Pascal Perney; Philippe Podevin; Paul S Haber; Helmut K Seitz; Christopher P Day; Philippe Mathurin; Timothy M Morgan; Devanshi Seth Journal: Alcohol Date: 2017-09-23 Impact factor: 2.405
Authors: Jennifer G Plebani; Carlos F Tirado; Helen M Pettinati; Kyle M Kampman; Joseph R Volpicelli; David W Oslin Journal: Addict Behav Date: 2009-09-10 Impact factor: 3.913
Authors: Scott H Stewart; Adrian Reuben; Walter A Brzezinski; David G Koch; Jan Basile; Patrick K Randall; Peter M Miller Journal: Alcohol Alcohol Date: 2009-06-17 Impact factor: 2.826