Am J Psychiatry 1997; 154:75-80
Copyright © 1997 by American Psychiatric Association
Superiority of carbohydrate-deficient transferrin to gamma- glutamyltransferase in detecting relapse in alcoholism
LG Schmidt, K Schmidt, P Dufeu, A Ohse, H Rommelspacher and C Muller
Department of Psychiatry, Benjamin Franklin University Hospital, Free University of Berlin, Germany.
OBJECTIVE: The usefulness of carbohydrate-deficient transferrin is widely
accepted in screening (male) population samples for heavy alcohol
consumption, but its role in relapse detection is not convincingly
established. The authors therefore compared the diagnostic value of
carbohydrate-deficient transferrin with the commonly used
gamma-glutamyltransferase in identifying relapsed alcoholics during
outpatient aftercare. METHOD: The patients were 101 male alcoholics who
entered a 6-month rehabilitation program after hospital detoxification.
Drinking status was assessed by means of self- and collateral reports
obtained during regular contacts with the rehabilitation team; relapse was
defined as consumption of any alcohol. Visits occurred weekly during month
1, biweekly during month 2, and every 4 weeks during months 3-6. At every
visit a blood sample was taken for measurement of carbohydrate-deficient
transferrin and gamma-glutamyltransferase. RESULTS: The proportion of men
who reported relapse was 25.6% per scheduled contact on average. Positive
predictive values indicated that relapse was identified with a 76.2%
probability by carbohydrate- deficient transferrin values above the upper
normal limit, in contrast to a 32.9% chance with gamma-glutamyltransferase.
Carbohydrate- deficient transferrin was especially useful in detecting
early relapses during the initial rehabilitation phase, when
gamma-glutamyltransferase values had not normalized. Because of the longer
half-life of gamma- glutamyltransferase, it had some value with a 4-week
monitoring schedule in detecting new drinking episodes in alcoholics whose
previous results had been normal. CONCLUSIONS: Carbohydrate-deficient
transferrin proved to be superior to gamma-glutamyltransferase in relapse
detection in an outpatient care setting for alcoholics.
