Der Stellenwert des kohlenhydratdefizienten Transferrin (CDT)

Zusammenfassung.

Alkoholkranke Patienten sind in der postoperativen Phase auf der Intensivstation durch die Dekompensation alkoholismusinduzierter Folgeerkrankungen vital bedroht. Vor allem das Alkoholentzugssyndrom (AES) provoziert interkurrente Komplikationen und prolongiert die intensivmedizinische Behandlungsphase. Zur präoperativen Evaluierung der Alkoholabhängigkeit stehen standardisierte, alkoholismusrelevante Anamneseverfahren und konventionelle klinisch-chemische Laborparameter, wobei diese häufig keine ausreichende Sensitivität und Spezifität besitzen. Unter den biologischen "State-Markern" zur Detektion des chronischen Abusus wird dem Kohlenhydrat-defizienten Transferrin (CDT) hohe Sensitivität und Spezifität zugeschrieben. Wir prüften bei 45 Patienten, die sich der Resektion maligner Tumoren des Oropharynx, Larynx oder Ösophagus unterzogen und anschließend auf der operativen Intensivstation weiterbehandelt wurden, ob CDT in der präoperativen Diagnostik chronischen Alkoholabusus detektieren kann. 21 Patienten wurden als Gruppe mit hohem Risiko für postoperative Alkoholismus-assoziierte Komplikationen identifiziert. Davon wurden 12 Patienten als chronische Abuser und 9 Patienten als abhängig eingestuft. CDT war bei den alkoholkranken Patienten in 16 von 21 Fällen pathologisch erhöht. Im Gegensatz dazu hatten alle Patienten, die dauerhaft abstinent (8 Patienten) oder länger als 7 Tage nüchtern waren (16 Patienten), normale CDT-Werte. CDT war bei unseren Patienten ein spezifischer und sensitiver Marker zur Detektion des chronischen Alkoholabusus.

Abstract.

The increase of alcoholism-related problems is associated with vital postoperative clinical complications in chronic alcohol abusers. In particular, the alcohol withdrawal syndrome (AWS) may provoke potentially life-threatening complications in alcohol-dependent patients. Hence, a precise diagnosis of alcohol dependence is mandatory preoperatively, requiring an extensive case history using alcoholism-associated questionnaires. Additional new biological markers for detecting alcoholism could improve the accuracy of preoperative diagnosis. Carbohydrate-deficient transferrin (CDT) reflects increased alcohol consumption. The aim of our interdisciplinary study was to investigate whether the validity of the preoperative diagnosis of chronic alcohol abuse might be improved by measuring CDT. Methods. A total of 45 patients from the departments of Otorhinolaryngology, Maxillofacial Surgery, and Abdominal and Thoracic Surgery were included in our prospective clinical study. Patients underwent resection of malignant oral, pharyngeal, laryngeal, or oesophageal tumours and were transferred to the intensive care unit for postoperative management. Routine preoperative history, examinations, and laboratory tests including GGT, MCV, ASAT, and ALAT, were supplemented by a specific alcohol-related questionnaire and CDT measurement. The patients were categorised in four groups based on history and the questionnaire: continuously abstinent subjects; sober subjects for at least 7 days; chronic abusers; and dependent subjects. CDT was separated by isocratic anion exchange chromatography and quantified by turbidimetric determination. Statistical analysis was performed by the Kruskal-Wallis test. Results. Preoperatively, 21 patients were at major risk for alcoholism-related complications: 12 were chronic abusers and 9 were diagnosed as dependent. CDT was significantly increased in both groups, and was pathologically elevated in 16 of the 21 patients. Sampling occurred significantly long after the last alcohol intake in the 5 patients with normal CDT values (median: 6.0 days; range: 2 – 12 days) compared with the 16 with pathologically elevated CDT levels (median: 1.0 day; range: 0 – 4 days; P=0.002). The sensitivity of CDT elevation was 16 out of 24 (76%), the specifity 16 out of 16 (100%). Sixteen patients had no previous history of alcohol consumption (sober for at least 7 days) and 8 were definitely abstinent. Both of these groups had normal CDT values. Conclusions. CDT was a sensitive and specific marker for chronic alcohol consumption in our patient population. Since CDT is a state marker, repeated determinations might be useful to estimate a patient's drinking habits. The combination of CDT and an alcohol-related questionnaire was reliable for detecting alcohol-dependent patients preoperatively.