Abstract
A variety of laboratory tests are available to assist in the diagnosis of alcohol consumption and related disorders. The levels of intake at which laboratory results become abnormal vary from person to person. Laboratory tests are particularly useful in settings where cooperativeness is suspected or when a history is not available. Several biochemical and hematological tests, such as γ-glutamyltransferase (GGT) activity, aspartate aminotransferase (AST) activity, high-density lipoprotein cholesterol (HDL-C) content of serum, and erythrocyte mean corpuscular volume (MCV) are established markers of alcohol intake. Their validity as markers is based largely on correlations with recent intake at a single time point and on decreases in elevated values when heavy drinkers abstain from alcohol. These readily available laboratory tests provide important prognostic information and should be integral part of the assessment of persons with hazardous alcohol consumption. There are several other markers with considerable potential for more accurate reflection of recent alcohol intake. These include carbohydrate deficient transferrin, β-hexosaminidase, acetaldehyde adducts and the urinary ratio of serotonin metabolites, 5-hydroxytryptophol and 5-hydroxyindoleacetic acid. These markers provide hope for more sensitive and specific aids to diagnosis and improved monitoring for intake.
Similar content being viewed by others
References
Ryback, R.S., Eckardt, M.J., Felsher, B. and Rawlings, R.R. (1982) Biochemical and histologic correlates of alcoholism and liver disease. J. Am. Med. Assoc. 248 (18), 2261–65.
Skinner, H.A., Holt, S., Schuller, R., Roy, J. and Israel, Y. (1984) Identification of alcohol abuse using laboratory tests and a history of trauma. Annals Internal Med. 101, 847–851.
Conigrave, K.M., Saunders, J.B. and Whitfield, J.B. (1995) Diagnostic tests for alcohol consumption. Alcohol and Alcoholism 30, 13–26.
Conigrave, K.M., Degenhardt, L.J., Whitfield, J.B., Saunders, J.B., Helander, A. and Tabakoff, B. (2002) CDT, GGT and AST as markers of alcohol use: the WHO/ISBRA collaborative project. Alcohol Clin. Exp. Res. 26, 332–339.
Rosalki, S. (1984) Identifying the alcoholic. In Clinical Biochemistry of Alcoholism, (Ed. Rosalki S) pp. 65–92. Churchill, Livingstone, Edinburgh.
Wu, A., Slavin, G. and Levi, A.J. (1976) Elevated serum gamma-glutamyl-transferase (transpeptidase) and histological liver damage in alcoholism. Am. J. Gastroenterol. 65, 318–323.
Lewis, K.O. and Paton, A. (1981) Tools of detection. Br. Med. J. 283, 1531–32.
Salaspuro, M. (1986) Conventional and coming laboratory markers of alcoholism and heavy drinking. Alcoholism. Clin. Exp. Res. 10, 5S-12S.
Whitfield, J.B., Hensley, W.J., Bryden, D. and Gallagher, H. (1978) Some laboratory correlates of drinking habits. Annal. Clin. Biochem. 15, 297–303.
Bellini, M., Tumino, E., Giordani, R., Fabrini, G., Costa, F., Galli, R., Rucco, M., Belcari, C., Michelassi, C., Murri, L., Maltini, G. and Marchi, S. (1997) Serum gamma glutamyl transpeptidase isoforms in alcoholic liver disease. Alcohol and Alcoholism, 32, 259–266.
Stefanini, G.F., Addolorato, G., Caputo, F., Olanda, S. and Gasbarrini, G. (1998) Can the gamma glutamyl transpeptidase isoforms really be utilized in the diagnosis of alcoholic liver disease? Alcohol and alcoholism: Int. J. Med. Council Alcoholism 33, 92–93.
Chick, J., Kreitman, N. and Plant, M. (1981) Mean-cell volume and gamma-glutamyl transpeptidase as markers of drinking in working men. Lancet i, 1249–1251.
Bell, H. and Steensland, H. (1987) Serum activity of gamma-glutamyltranspeptidase (GGT) in relation to estimated alcohol consumption and questionnaires in alcohol dependence syndrome. British J. Addiction 82, 1021–1026.
Sillanaukee, P., Seppa, K., Koivula, T., Israel, Y. and Niemela, O. (1992) Acetaldehyde-modified hemoglobin as a marker of alcohol consumption: comparison of two new methods. J. Lab. Clin. Med. 120, 42–47.
Kew, M.C. (2000) Serum aminotransferase concentration as evidence of hepatocellular damage. Lancet 355(9204), 591–592.
Rej, R. (1978) Aspartate aminotransferase activity and isoenzyme proportions in human liver tissues. Clin. Chem. 24, 1971–1979.
Panteghini, M., Falsetti, F., Chiari, E. and Malshiodi, A. (1983) Determination of aspartate aminotransferase isoenzymes in hepatic disease—preliminary findings. Clinica Chimica Acta 128, 133–140.
Wadstein, J. and Skude, G. (1979) Changes in amylase, hepatic enzymes and bilirubin in serum upon initiation of alcohol abstinence. Acta. Med. Scand. 205, 313–6.
Ahlgren, A., Hedenborg, G., Norman, A. and Wisen, O. (1988) Serum bilirubin subfractions in patients with alcohol abuse during detoxication. Scand. J. Clin. Lab. Invest. 48, 319–26.
Skinner, H.A., Holt, S., Sheu, W.J. and Israel, Y. (1986). Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index. Br. Med. J. 292: 1703–08.
Chalmers, D.M., Grinsler, M.G., MacDermott, S., Spicer, C.C. and Levi, A.J. (1981) Biochemical and haematological indicators of excessive alcohol consumption. Gut. 22, 992–996.
Paton, A. (1994) In: ABC of Alcohol. (Ed. A Paton), BMJ Publishing, USA.
Annoni, G., Weiner, F.R., Colombo, M., Czaja, M.J. and Zern, M.A. (1990) Albumin and collagen gene regulation in alcohol- and virus-induced human liver disease. Gastroenterology 98, 197–202
Rothschild, M.A., Oratz, M. and Schreiber, S.S. (1983) Effects of nutrition and alcohol on albumin synthesis. Alcohol Clin. Exp. Res. 7, 28–30
Oratz, M., Rothschild, M.A. and Schreiber, S.S. (1978) Alcohol, amino acids, and albumin synthesis. III. Effects of ethanol, acetaldehyde, and 4-methylpyrazole. Gastroenterology 74, 672–6.
Oratz, M., Rothschild, M.A. and Schreiber, S.S. (1976) Alcohol, amino acids, and albumin synthesis. II. Alcohol inhibition of albumin synthesis reversed by arginine and spermine. Gastroenterology 71, 123–7.
Waern, A.U. and Hellsing, K. (1980) Indices of alcohol intake. Comparison between serum concentrations of alkaline phosphatase and gamma glutamyltransferase in middle-aged men. Ups. J. Med. Sci. 85, 159–63.
Donohue, T.M., Zetterman, R.K., Zhang-Gouillon, Z.Q. and French, S.W. (1998) Peptidase activities of the multicatalytic protease in rat liver after voluntary and intragastric ethanol administration. Hepatol. 28, 486–91.
Trotti, R., Carratelli, M., Barbieri, M., Micieli, G., Bosone, D., Rondanelli, M. and Bo, P. (2001) Oxidative stress and a thrombophilic condition in alcoholics without severe liver disease. Haematologica 86, 85–91.
Wisniewska-Knypl, J.M. and Wronska-Nofer, T. (1994) Biological markers of oxidative stress induced by ethanol and iron overload in rat. Int. J. Occup. Med. Environ. Health 7, 355–63.
Hoffmann, T., Meyer, R.J., Sorrell, M.F. and Tuma, D.J. (1993) Reaction of acetaldehyde with proteins: formation of stable fluorescent adducts. Alcoholism Clin. Exp. Res. 17, 69–74.
Eriksson, C.J.P. and Fukunaga, T. (1993) Human blood acetaldehyde (update 1992). Alcohol and Alcoholism Suppl. 2, 9–25.
Halvorson, M.R., Campbell, J.L., Sprague, G., Slater, K., Noffsinger, J.K. and Peterson, C.M. (1993) Comparative evaluation of the clinical utility of three markers of ethanol intake: the effect of gender. Alcoholism Clin. Exp. Res. 17, 225–228.
Niemela, O., Juvonen, T. and Pakkila, S. (1991) Immunohistochemical demonstration of acetaldehyde-modified epitopes in human liver after alcohol consumption. J. Clin. Inv. 87, 1367–1374.
Niemela, O. and Israel, Y. (1992) Hemoglobin-acetaldehyde adducts in human alcohol abusers. Lab. Invest. 67, 246–252.
Niemela, O., Israel, Y., Mizoi, Y., Fukunaga, T. and Eriksson, C.J.P. (1990) Hemoglobin-acetaldehyde adducts in human volunteers following acute ethanol ingestion. Alcoholism Clin. Exp. Res. 14, 838–841.
Israel Y, Orego H, Niemela O (1988). Immune responses to alcohol metabolites: pathogenic and diagnostic implications. Seminars in Liver Disease. 8, 81–90.
Worral, S., deJersy, J., Shanley, B.C. and Wilce, P.A. (1991) Antibodies against acetaldehyde-modified epitopes: an elevated IgA response in alcoholics. Eur. J. Clin. Invest. 21, 90–95.
Lin, C.C., Potter, J.J. and Mezey, E. (1984) Erythrocyte aldehyde dehydrogenase activity in alcoholism. Alcoholism Clin. Exp. Res. 8, 539–541.
Johnson, R.D., Bahgnisch, J., Steward, B., Shearman, D.J.C. and Edwards, J.B. (1992) Optimized spectrophotometric determination of aldehyde dehydrogenase activity in erythrocytes. Clin. Chem. 38, 584–588.
Huang, Y.S., Chan, C.Y., Wu, J.C., Pai, C.H., Chao, Y. and Lee, S.D. (1994) Serum levels of interleukin-8 in alcoholic liver disease: relationship with disease stage, biochemical parameters and survival. J. Hepatol. 24, 377–384.
DeGoede, E. and Yap, S.H. (1997). Exceptional high concentration of serum CA 19.9 in a patient with alcoholic liver disease. Gut 41, 579–580.
Ohhira, M., Ohtake, T., Saito, H., Ikuta, K., Tanaka, K., Tanabe, H., Kawashima, T., Fujimoto, Y., Naraki, T., Ono, M. and Kohgo, Y. (1999) Increase of serum des-gamma-carboxy prothrombin in alcoholic liver disease without hepatocellular carcinoma. Alcoholism Clin. Exp. Res. 23, 67S-70S.
Hultberg, B., Isaksson, A. and Tiderstrom, G. (1980) β-Hexosaminidase, leucine aminopeptidase, cystidyl aminopeptidase, hepatic enzymes and bilirubin in serum of chronic alcoholics with acute ethanol intoxication. Clinica Chemic Acta 105, 317–323.
Karkkainen, P., Poikolainen, K. and Salaspuro, M. (1990) Serum β-Hexosaminidase as a marker of heavy drinking. Alcoholism Clin. Exp. Res. 14, 187–190.
Nystrom, M., Perasalo, J. and Salaspuro, M. (1991) Serum β-hexosaminidase in young university students. Alcoholism Clin. Exp. Res. 15, 877–880.
Cameron, R.G. and Neuman, M.G. (1999) Novel morphologic finding in alcoholic liver disease. Clin. Biochem. 32, 579–584.
Urashima, S., Tsutsumi, M., Shimanaka, K., Ueshima, Y., Tsuchishima, M., Itoh, T., Kawahara, H. and Takase, S. (1999) Histochemical study of hyaluronate in alcoholic liver disease. Alcoholism Clin. Exp. Res. 23, 56S-60S.
Philips, E.L.R., Little, R.E., Hillman, R.S., Labbe, R.F. and Campbell, C. (1984) A field test of the sweat patch. Alcoholism Clin. Exp. Res. 8, 233–237.
Swift RM, Martin CS, Swette L, LaConti A, Kackley N (1992) Studies of a wearable, electronic, transdermal alcohol sensor. alcoholism Clin. Exp. Res. 16, 721–725.
Voltaire A, Beck O, Borg S (1992) Urinary 5-hydroxytryptophol: a possible marker of recent alcohol consumption. Alcoholism Clin. Exp. Res. 16, 281–285.
Matsuda, Y., Takada, A., Kanayama, R. and Takase, S. (1983) Changes of hepatic microtubules and secretory proteins in human alcoholic liver disease. Pharmacol, Biochem Behaviour. 18 (suppl 1): 479–482.
Stibler, H. (1991) Carbohydrate-deficient transferrin in serum: a new marker of potentially harmful alcohol consumption reviewed. Clin. Chem. 37, 2029–2037.
Ghosh, P., Okoh, C., Liu, Q.H. and Lakshman, M.R. (1993) Effects on chronic ethanol on enzymes regulating sialylation and desialylation of transferrin in rats. Alcoholism Clin. Exp. Res. 17, 576–579.
Behrens, U.J., Worner, T.M., Braly, L.F., Schaffner, F. and Leber, C.S. (1988) Carbohydrate-deficient transferrin, a marker for chronic alcohol consumption in different ethnic populations. Alcoholism Clin. Exp. Res. 12, 427–432.
Chan, A.W.K., Leong, F.W., Schanley, D.L., Welte, J.W., Wieczoreck, W., Rej, R. and Whitney, R.B. (1989) Transferrin and mitochondrial aspartate aminotransferase in young adult alcoholics. Drug and Alcohol Dependence. 23, 13–18.
Stibler, H., Borg, S. and Beckman, G. (1988) Transferrin phenotype and level of carbohydrate-deficient transferrin in healthy individuals. Alcoholism Clin. Exp. Res. 12, 450–453.
Xin, Y., Rosman, A.S., Lasker, J.M. and Lieber, C.S. (1992) Measurement of carbohydrate—deficient transferrin by isoelectric focussing/western blotting and by micro anion-exchange chromatography/radioimmunoassay: comparison of diagnostic accuracy. Alcohol and Alcoholism. 27, 425–433.
Stibler, H., Borg, S. and Allgulander, C. (1979) Clinical significance of abnormal heterogeneity of transferrin in relation to alcohol consumption. Acta Med. Scand. 206, 275–81.
Scouller, K., Conigrave, K.M., Macaskill, P., Irwig, L. and Whitfield, J.B. (2000) Should we use carbohydrate-deficient transferrin instead of γ-glutamyl transferase for detecting problem drinkers? Asystemic review ad metaanalysis. Clin. Chem. 46, 1894–1902.
Beresford, T.P., Blow, F.C., Hill, E., Singer, K. and Lucey, M.R. (1990) Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism. Lancet 336, 482–485.
Lichtenstein, M.J., Burger, M.C., Yarnell, J.W.G., Elwood, P.C. and Sweetnam, P.M. (1989) Derivation and validation of a prediction rule for identifying heavy consumers of alcohol. Alcoholism Clin. Exp. Res. 13, 626–630.
Conigrave, K.M., Saunders, J.B., Reznik, R.B. and Whitfield, J.B. (1993) Prediction of alcohol-related harm by laboratory test results. Clin. Chem. 39, 2266–2270.
Lumeng, L. (1986) New diagnostic marker of alcohol abuse. Hepatol. 6, 742–45.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Das, S.K., Nayak, P. & Vasudevan, D.M. Biochemical markers for alcohol consumption. Indian J Clin Biochem 18, 111–118 (2003). https://doi.org/10.1007/BF02867376
Issue Date:
DOI: https://doi.org/10.1007/BF02867376