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Open Access Research article

Diagnostic sensitivity of carbohydrate deficient transferrin in heavy drinkers

Kevin J Fagan12, Katharine M Irvine2, Brett C McWhinney4, Linda M Fletcher13, Leigh U Horsfall12, Lambro Johnson4, Peter O’Rourke5, Jennifer Martin36, Ian Scott6, Carel J Pretorius4, Jacobus PJ Ungerer4 and Elizabeth E Powell12*

Author Affiliations

1 Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba 4102, Brisbane, Queensland, Australia

2 Centre for Liver Disease Research, School of Medicine, The University of Queensland, Brisbane, Australia

3 School of Medicine, The University of Queensland, Brisbane, Australia

4 Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia

5 Cancer and Population Studies Group, Queensland Institute of Medical Research, Brisbane, Australia

6 Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia

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BMC Gastroenterology 2014, 14:97  doi:10.1186/1471-230X-14-97

Published: 22 May 2014


Background and Aim

Carbohydrate deficient transferrin (CDT) is the most specific serum biomarker of heavy alcohol consumption, defined as ≥ 350–420 g alcohol/week. Despite introduction of a standardized reference measurement technique, widespread use of CDT remains limited due to low sensitivity. The aim of this study was to determine the factors that affect diagnostic sensitivity in patients with sustained heavy alcohol intake.


Patients with a self-reported history of sustained heavy alcohol consumption were recruited from the hepatology outpatient department or medical wards. Each patient was interviewed with a validated structured questionnaire of alcohol consumption and CDT analysis using the standardized reference measurement technique with high performance liquid chromatography was performed on serum collected at time of interview.


52 patients were recruited: 19 from the hepatology outpatient department and 33 from general medical wards. Median alcohol intake was 1013 (range 366–5880) g/week over the preceding two week period. 26 patients had a diagnostic CDT based on a threshold value of %CDT > 1.7 indicating heavy alcohol consumption, yielding a sensitivity of 50%. Overweight/obesity (defined as body mass index (BMI) ≥ 25 kg/m2 in Caucasians and ≥ 23.0 kg/m2 in Asians), female gender and presence of cirrhosis were independently associated with non-diagnostic %CDT (≤ 1.7).


CDT has limited sensitivity as a biomarker of heavy alcohol consumption. Caution should be applied when ordering and interpreting %CDT results, particularly in women, patients with cirrhosis and those with an elevated BMI.

Alcohol; High performance liquid chromatography; Cirrhosis; Biomarker; Obesity