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.
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Results of Screening Tests for Unhealthy Alcohol Use
(Optimal sensitivities corresponding to a specificity >0.8) |
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Men (n=787)
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Women (n=446)
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| 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
|
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.