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Exclusion of trisialo-transferrin from carbohydrate-deficient transferrin measurement: advantage in patients with chronic liver disease?

Ausschluss von trisialo-transferrin von der Carbohydrate-Deficient-Transferrin-Messung

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Zusammenfassung

HINTERGRUND: Biologische Marker des chron. Alkoholkonsums wie MCV, GGT oder Carbohydrate Deficient transferrin (CDT) sind klinisch hilfreich, jedoch nicht absolut aussagekräftig. Besonders bei Patienten mit bereits etablierter Lebererkrankung wäre ein verlässlicher Marker des chronischen Alkoholkonsums zum Erkennen der zu Grunde liegenden Krankheitsätiologie höchst wünschenswert. Die Messung des CDT wurde durch eine verbesserte ELISA Version, die Asialo-, Monosialo- und Disialo-Transferrin misst, nicht jedoch das Trisialo- Transferrin inkludiert weiterentwickelt und verspricht höhere Sensitivität und Spezifität in der Aufdeckung eines kürzlich entdeckten Alkoholkonsums. ZIEL: Studienziel war es bei Patienten mit Lebererkrankung Sensitivität, Spezifität, positiv und negativ prädiktiven Wert des CDT-TRISIALO (−) mit dem CDT-TRISIALO (+) zu vergleichen. PATIENTEN UND METHODEN: Die Studienpopulation bestand aus 110 konsekutiven Patienten (männlich: n = 80 [72,7 %], weiblich: n = 30 [27,3 %]) mit Lebererkrankung der folgenden ätiologischen Kategorien: chronischer Alkoholkonsum (n = 51 [46,4 %], chronische Virushepatitis (n = 33 [30,0 %], Hämochromatose (n = 4 [3,6 %]), mechanische Cholestase (n = 17 [15,5 %]) und andere Lebererkrankungen (n = 5). 30 Patienten hatten keine Leberzirrhose, bei der Mehrheit (n = 80) fand sich eine Leberzirrhose. ERGEBNISSE: Bei Patienten mit Lebererkrankung hatte der CDT-TRISIALO (−) Test beim publizierten Cut-off Wert von 2,6 % eine Sensitivität von 72,7 % und eine Spezifität von 58,1 % für rezent zurückliegenden Alkoholkonsum. Der positiv prädikitve Wert war 34,0 % und der negativ prädiktive Wert 87,8 %. Der CDT TRISIALO (+) Test erreichte bei einem empfohlenen Cut-off Level von 4,7 % mit 73,3 % und 49,3 % ähnliche Sensitivitäts- und Spezifitätswerte. Positiver und negativer prädiktiver Wert lagen bei 30,9 % bzw. 88,1 % Sowohl CDT-TRSIALO (+) als auch CDT-TRSISIALO (−) korrelierten positiv mit dem Child-Pugh Leberzirrhose Stadium. ZUSAMMENFASSUNG: Der modifizierte Carbohydrate Deficient Transferrin (CDT) Test (CDT-TRISIALO (−)) zeigte in einer Gruppe von Patienten mit Lebererkrankung keinen eindeutigen Vorteil gegenüber dem etablierten CDTTRISIALO (+) Test. In einer Population von Patienten mit Lebererkrankungen kann ein normales Ergebnis des sowohl CDT-TRISIALO (+) als auch des CDT-TRISIALO (−) Tests als Argument für den Ausschluss eines rezenten Alkoholgebrauchs gelten.

Summary

BACKGROUND: Biological markers for chronic alcohol consumption like MCV or γGT or carbohydrate deficient transferrin (CDT) are useful, but far from being perfect. In patients with liver disease a reliable marker for chronic alcohol consumption as the underlying etiology is highly needed. Recently, a new ELISA based version of the carbohydrate-deficient-transferrin (CDT-TRISIALO (−)) assay has been developed, which measures asialo-, monosialo- and disialo transferrin, but excludes trisialo- transferrin; that modification suggests higher sensitivity and specificity in detecting recent alcohol consumption in patients. AIMS: The study goal was to evaluate the sensitivity, specificity, positive and negative predicitive value of this new carbohydrate-deficient-transferrin assay (CDT-TRISIALO (−)) in a group of patients with liver disease and to compare the results with that of the established CDT assay (CDT-TRISIALO (+)). PATIENTS AND METHODS: Our study population consisted of 110 consecutive patients (male: n = 80 [72.7 %], female: n = 30 [27.3 %]) with liver disease of the following etiologies: chronic alcohol consumption (n = 51 [46.4 %]; Out of them 30 alcohol abusing patients were assessed by cage = 1 and 21 alcohol dependent patients were assessed by cage = 2, chronic viral hepatitis (n = 33 [30.0 %]) including 25 [22.7 %] patients with chronic hepatitis C infection and 8 [7.3 %] patients with chronic hepatitis B infection), haemochromatosis (n = 4 [3.6 %]), mechanical cholestasis (n = 17 [15.5 %]) and other liver diseases (n = 5 [4.6 %] including autoimmune hepatitis (n = 2) and primary biliary cirrhosis (n = 3)). 27.3 % of our patients (n = 30) had no liver cirrhosis whereas the majority (72.7 %, n = 80) had liver cirrhosis. RESULTS: In our population of liver disease patients the CDT-TRISIALO (−) assay had a sensitivity of 72.7 % and specificity of 58.1 % for recent alcohol consumption at the published cutoff level of 2.6 %. The positive predictive value was 34.0 % and the negative predictive value was 87.8 %. Sensitivity and specificity of the CDT-TRISIALO (+) assay at the recommended cutoff level of 4.7 % were similar, 77.3 % and 49.3 %, respectively. The positive and negative predictive values were 30.9 % and 88.1 %. CDTTRISIALO (+) and CDT-TRISIALO (−) levels increased significantly with higher Child-Pugh stages. CONCLUSION: The newly developed carbohydrate deficient transferrin test (CDT-TRISIALO (−)) is of no advantage as compared to the established assay (CDT-TRISIALO (+)) when used in a patient population with liver disease. In that population, normal CDT-TRISIALO (−) helps to exclude recent alcohol consumption; this results from the high negative predictive value of a normal CDT-TRISIALO (−).

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Authors and Affiliations

  1. Klinische Abteilung Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin IV, University of Vienna, Austria

    Maximilian Schöniger-Hekele & Christian Müller

  2. Universitätsklinik für Psychiatrie, Zentralbereich, University of Vienna, Austria

    Katrin Ramskogler, Doris Hartl & Otto M. Lesch

  3. Anton Proksch Institut Wien, Vienna, Austria

    Otto M. Lesch

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  1. Maximilian Schöniger-Hekele
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  2. Katrin Ramskogler
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  3. Doris Hartl
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  4. Otto M. Lesch
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  5. Christian Müller
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Correspondence to Christian Müller.

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Schöniger-Hekele, M., Ramskogler, K., Hartl, D. et al. Exclusion of trisialo-transferrin from carbohydrate-deficient transferrin measurement: advantage in patients with chronic liver disease?. Wien Med Wochenschr 156, 216–222 (2006). https://doi.org/10.1007/s10354-005-0238-5

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  • DOI: https://doi.org/10.1007/s10354-005-0238-5

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