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Research Summary

Do Biomarkers Improve the Accuracy of Alcohol Screening in Acutely Injured Adults?

Administration of self-report questionnaires is recommended for the detection of unhealthy alcohol use in acutely injured patients; however, it may lead to false negatives if there is underreporting. To assess whether alcohol biomarkers added accuracy to questionnaire-based alcohol screening in injured patients, 1233 acutely injured adults presenting to a German teaching hospital completed the Alcohol Use Disorders Identification Test (AUDIT) to assess the presence of unhealthy alcohol use.* Sixteen percent of all subjects (20% of men and 10% of women) had unhealthy alcohol use. Area-under-the-curve (AUC) analysis was used to compare the accuracy of the AUDIT with gamma-glutamyl-transferase (GGT), carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), and the AUDIT plus all 3 biomarkers for detecting unhealthy alcohol use. An AUC of 1.0 would indicate a perfect test and 0.5 would be a test no better than chance.

Results of Screening Tests for Unhealthy Alcohol Use
(Optimal sensitivities corresponding to a specificity >0.8)
 
Men (n=787)
Women (n=446)
 Test
Sensitivity
Specificity
AUC
Sensitivity
Specificity
AUC
 AUDIT
0.75
0.84
0.874
0.79
0.85
0.889
 GGT
0.43
0.82
0.660
0.21
0.83
0.522
 CDT
0.43
0.82
0.669
0.40
0.81
0.595
 MCV
0.36
0.84
0.652
0.28
0.85
0.576
 All biomarkers
0.56
0.78
--
0.26
0.86
--
 AUDIT + all  biomarkers
0.87
0.68
0.890
0.84
0.74
0.900
*Defined in this study as high-risk drinking (alcohol consumption >420 g per week in men and >280 g per week in
women) or as harmful or dependent drinking per ICD-10 criteria. Cutoffs for men and women, respectively, were
for AUDIT >8 and >5, GGT >21 U/l and >14 U/l, CDT >2.9% and >2.7%, and MCV >92 fl and >93 fl.

Comments:

This study demonstrates the superiority of the AUDIT over alcohol biomarkers for detecting AUDs in injured patients (see Table). Although adding all 3 biomarkers to the AUDIT did increase the screening sensitivity in both men and women, this came at a cost of decreased specificity and no significant change in AUC.

Kevin L. Kraemer, MD, MSc

Reference:

Neumann T, Gentilello LM, Neuner B, et al. Screening trauma patients with the Alcohol Use Disorders Identification Test and biomarkers of alcohol use. Alcohol Clin Exp Res. 2009:33(6):970–976.


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