[The relevance of CDT (carbohydrate-deficient transferrin). Preoperative diagnosis of chronic alcohol abuse in intensive care patients following elective tumor resection]. / Der Stellenwert des kohlenhydratdefizienten Transferrin (CDT). Präoperative Diagnostik des chronischen Alkoholabusus bei intensivmedizinischen Patienten nach elektiver Tumorresektion.

ABSTRACT

The increase of alcoholism-related problems is associated with vital postoperative clinical complications in chronic alcohol abusers. In particular, the alcohol withdrawal syndrome (AWS) may provoke potentially life-threatening complications in alcohol-dependent patients. Hence, a precise diagnosis of alcohol dependence is mandatory preoperatively, requiring an extensive case history using alcoholism-associated questionnaires. Additional new biological markers for detecting alcoholism could improve the accuracy of preoperative diagnosis. Carbohydrate-deficient transferrin (CDT) reflects increased alcohol consumption. The aim of our interdisciplinary study was to investigate whether the validity of the preoperative diagnosis of chronic alcohol abuse might be improved by measuring CDT. METHODS. A total of 45 patients from the departments of Otorhinolaryngology, Maxillofacial Surgery, and Abdominal and Thoracic Surgery were included in our prospective clinical study. Patients underwent resection of malignant oral, pharyngeal, laryngeal, or oesophageal tumours and were transferred to the intensive care unit for postoperative management. Routine preoperative history, examinations, and laboratory tests including GGT, MCV, ASAT, and ALAT, were supplemented by a specific alcohol-related questionnaire and CDT measurement. The patients were categorised in four groups based on history and the questionnaire continuously abstinent subjects; sober subjects for at least 7 days; chronic abusers; and dependent subjects. CDT was separated by isocratic anion exchange chromatography and quantified by turbidimetric determination. Statistical analysis was performed by the Kruskal-Wallis test. RESULTS. Preoperatively, 21 patients were at major risk for alcoholism-related complications 12 were chronic abusers and 9 were diagnosed as dependent. CDT was significantly increased in both groups, and was pathologically elevated in 16 of the 21 patients. Sampling occurred significantly long after the last alcohol intake in the 5 patients with normal CDT values (median 6.0 days; range 2-12 days) compared with the 16 with pathologically elevated CDT levels (median 1.0 day; range 0-4 days; P = 0.002). The sensitivity of CDT elevation was 16 out of 24 (76%), the specificity 16 out of 16 (100%). Sixteen patients had no previous history of alcohol consumption (sober for at least 7 days) and 8 were definitely abstinent. Both of these groups had normal CDT values. CONCLUSIONS. CDT was a sensitive and specific marker for chronic alcohol consumption in our patient population. Since CDT is a state marker, repeated determinations might be useful to estimate a patient's drinking habits. The combination of CDT and an alcohol-related questionnaire was reliable for detecting alcohol-dependent patients preoperatively.