Use of Carbohydrate-Deficient Transferrin (CDT) and a Combination of GGT and CDT (GGT–CDT) to Assess Heavy Alcohol Consumption in Traffic Medicine

• Published in: Alcohol and alcoholism (Oxford) Vol. 45; no. 3; pp. 247 - 251
• Main Authors: Bianchi, Vincenza, Ivaldi, Alessandra, Raspagni, Alessia, Arfini, Carlo, Vidali, Matteo
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2010
• Subjects: Accidents; Accidents, Traffic; Adult; Alcohol abuse; Alcoholism - blood; Alcoholism - diagnosis; Alcoholism and acute alcohol poisoning; Automobile Driving - legislation & jurisprudence; Biological and medical sciences; Biomarkers - blood; Blood alcohol level; Central Nervous System Depressants - blood; Chromatography, High Pressure Liquid; Drivers; Ethanol - blood; Female; gamma-Glutamyltransferase - blood; Gas Chromatography-Mass Spectrometry; Humans; Italy; Male; Medical sciences; Predictive Value of Tests; Reagent Kits, Diagnostic; Sex Characteristics; Toxicology; Traffic; Transferrin - analogs & derivatives; Transferrin - metabolism; Italy; Consumption; Medicine; Alcoholic beverage; Association; Carbohydrate deficient transferrin
• ISSN: 0735-0414; 1464-3502
• DOI: 10.1093/alcalc/agq006

Aims: Carbohydrate-deficient transferrin (CDT) has become widely used in traffic medicine to detect chronic alcohol abuse among subjects applying for driving-license renewal or regranting. By defining cut-off values in a large population of abstainers and moderate drinkers, we report on CDT, GGT–CDT (a combination of gamma-glutamylaminotransferase (GGT) and CDT) and the association between blood alcohol concentration (BAC) and CDT among Italian drivers. Methods: CDT was evaluated by a high performance liquid chromatography (HPLC)-based commercial kit in 652 abstainers or moderate drinkers, 603 drivers applying for driving-license regranting after a rehabilitation programme and 105 drivers involved in car accidents with blood alcohol concentration higher than the legal limit used in Italy (BAC >0.5g/l). GGT–CDT was calculated according to Sillanaukee and Olsson and Niemelä. BAC has been assessed by gas chromatography–mass spectrometry. Results: A common CDT cut-off (1.8%) and gender-specific GGT–CDT cut-off (4.15% for males, 3.56% for females) were calculated as 99.9th percentiles of the control population. Also, 3% and 27% of subjects were classified as CDT positive respectively among drivers applying for license regranting and drivers involved in car accidents. A significant association between BAC and both CDT values and CDT positivity was found, with a frequency up to 49% of CDT samples, suggesting chronic alcohol abuse, among drivers with BAC >2.5g/l. Concordance between CDT and GGT–CDT was only moderate (kappa = 0.44), with CDT performing better than GGT–CDT. Conclusions: A relevant proportion of drivers with high BAC are chronic abusers. GGT–CDT, previously validated with CDT immunoassays, should not be applied to traffic medicine in its current form and its performances re-evaluated with CDT measured by HPLC.