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Monitoring of alcohol consumption by living persons takes place in various contexts, amongst which workplace drug testing, driving under the influence of alcohol, driving licence regranting programs, alcohol withdrawal treatment, diagnosis of acute intoxication or fetal alcohol ingestion. The matrices that are mostly used today include blood, breath and urine. The aim of this review is to present alternative sampling strategies that allow monitoring of the alcohol consumption in living subjects. Ethanol itself, indirect (carbohydrate deficient transferrin, CDT%) as well as direct biomarkers (ethyl glucuronide, EtG; ethyl sulphate, EtS; fatty acid ethyl esters, FAEEs and phosphatidylethanol species, PEths) of ethanol consumption will be considered. This review covers dried blood spots (CDT%, EtG/EtS, PEths), dried urine spots (EtG/EtS), sweat and skin surface lipids (ethanol, EtG, FAEEs), oral fluid (ethanol, EtG), exhaled breath (PEths), hair (EtG, FAEEs), nail (EtG), meconium (EtG/EtS, FAEEs), umbilical cord and placenta (EtG/EtS and PEth 16:0/18:1). Main results, issues and considerations specific to each matrix are reported. Details about sample preparation and analytical methods are not within the scope of this review.

Objective: The aim of this study was to provide a tool based on CDT measurements for a diagnostic approach to identify patients affected by congenital disorders of glycosylation (CDG) in a selected population. Design and methods: Serum carbohydrate-deficient transferrin (CDT) of pediatric and adult patients (a total of 168 individuals) with neurological symptoms was analyzed. Abnormal results were confirmed by HPLC analysis and by enzymatic and molecular studies. Results: We found 6 patients (3.8%) with abnormal serum CDT; only two of them (1.9%) showed increased amounts of disialo and asialo with HPLC analysis and were classified as CDG-Ia, the most frequent form of CDG, due to a deficiency of the phosphomannomutase enzyme. Conclusions: The CDT quantitative immunoturbidimetric procedure is a useful tool for CDG screening. HPLC analysis, however, permitted the correct identification of asialo and disialo transferrin concentrations.

Objectives Ethyl glucuronide in hair (hEtG) and serum carbohydrate deficient transferrin (%CDT) are valuable markers for alcohol abuse, but their diagnostic accuracy to monitor abstinence and relapse is unclear. Here, we investigate to what extent repeated measurements of hEtG and %CDT can be used to monitor relapse in alcohol-dependent patients during abstinence treatment. Design and methods HEtG and %CDT were measured in individuals starting treatment for alcohol dependence both at treatment entry and 3 months later. Alcohol consumption and relapse episodes were recorded using the Time Line Follow Back and by alcohol breath and urine tests, and correlated with hEtG and %CDT measurements. Results Fifteen patients completed the study, of which nine had one or more relapses. Hair EtG and serum %CDT identified whether a relapse occurred in 78% and 57% of cases, respectively. Only hEtG correlated with the amount of alcohol consumed before treatment entry (Pearson r = 0.92; p < 0.001). The specificity of %CDT to assess abstinence during treatment was 100%. HEtG had a specificity of only 17%; however, in all patients who remained abstinent, hEtG decreased with > 85% from initial values. Mean hEtG, but not %CDT, differed significantly between patients who relapsed and patients who remained abstinent (p = 0.034). Conclusions HEtG was more sensitive than serum %CDT to assess relapse in alcohol-dependent patients and was positively correlated with the amounts of alcohol consumed. In contrast, serum %CDT was more specific for assessing abstinence. We highlight the benefit of repeated measurements of hEtG and serum %CDT for monitoring abstinence during treatment.

Carbohydrate-deficient transferrin is a well-known biomarker widely used for detection of chronic excessive alcohol intake. However, under certain clinical conditions particularly frequently met amongst heavy drinkers (steatosis, fibrosis, cirrhosis…), it isn't a reliable biomarker. In this study, we tried to find additional biomarkers to CDT in order to improve detection of chronic excessive alcohol intake.We conducted a retrospective cohort study from December 2007 to December 2009. We focused mainly on three different groups: heavy drinking patients with active alcohol consumption (n=243), cirrhotic patients (abstinent patients and non alcoholic cirrhosis, n=44) and control group (n=85).In our study, CDT showed a poor sensitivity for diagnosis of heavy drinking patients (around 63%, and even lower) for cirrhotic patients and patients at advanced stage of fibrosis. Combination of CDT with trisialotransferrin enabled to improve significantly sensitivity and specificity (p-value AUC ROC0.001). When adding mean corpuscular volume and gamma-glutamyltransferase to this first combination, performances were even better (p-value0.001). This second cluster enabled to make a statistically significant difference between cirrhotic patients with active alcohol consumption compared to abstinent cirrhotic patients and to non alcoholic cirrhotic patients (p-value0.001).From our study, trisialotransferrin seems to be a useful additional biomarker to CDT in order to improve detection of chronic excessive alcohol intake.

Objective The aim of this study was to evaluate the CEofix™ CDT Capillary Electrophoresis (CE) kit for the detection of β-2-tranferrin (β-2-Tf) in cerebrospinal fluid (CSF). Design and method Evaluation was performed according to CLSI EP5-A and EP12-A guidelines. Results The method resolved β-2-Tf from other Tf isoforms. The C50 for β-Tf was determined to be 0.46 mg/L. Neither hemoglobin nor bilirubin co-migrated with β-2-Tf. Conclusions The CDT kit can be used for detecting β-2-Tf in CSF by CE.

Objectives Chronic kidney disease stage V is associated with a metabolic acidosis, a disturbance also observed in heavy alcohol consumption. Carbohydrate-deficient transferrin is considered the most accurate biomarker for identifying chronic alcohol abuse. We tested whether increased CDT results occurred in patients on dialysis therapy. Design and methods One hundred twenty-two samples from HD patients were analyzed by three different analytical methods and the results were compared with those obtained in 48 healthy volunteers. Results On the basis of the upper 97.5th percentile, positive CDT results were found in 25.4%, 9.8% and 12.3% of the HD patients with particle-enhanced immunonephelometry, capillary electrophoresis and HPLC, respectively. A significant correlation between CDT values and transferrin concentration was found for the particle-enhanced immunonephelometric test ( r : −0.311; p : 0.0009). Conclusions A high rate of positive CDT results was observed in HD patients with the particle-enhanced immunonephelometry and seems to be related to the low transferrin concentration.

Objectives: Novel comparison of CDT isoforms as determined by CE with an FDA-approved immunoassay kit. Design and methods: Subjects ( n = 51) were categorized by drinking status based on AUDIT questionnaire responses. CDT isoform analyses by CE were compared to a commercially available, FDA-approved immunoassay. The analytical specificity of the immunoassay kit was assessed by analysis with IEF. Results: Because of the poor correlation between % CDT as measured by CE and the TIA immunoassay and between subject-reported drinking levels and results from the TIA assay, extraction column eluants from the immunoassays were analyzed by IEF for analytical specificity. % CDT by TIA included some trisialo-Tf, a non-CDT fraction, in the % CDT determination. Conclusions: Total % CDT by CE, which separates all isoforms is more analytically specific than immunoassays because it does not include trisialo-Tf in the CDT calculation.

Objectives To describe the serious health consequences of alcohol (ethanol) use, especially as they relate to pregnancy and the development of fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). The classic markers of alcohol exposure, including blood/breath alcohol, γ-glutamyl transferase (γGT), mean corpuscular volume (MCV), hemoglobin-associated acetaldehyde (HAA) and carbohydrate deficient transferrin (CDT), are valuable and their methods of analysis are reviewed. Conclusions Since both FAS and FAE represent two of the leading preventable causes of mental retardation and birth defects, identification of alcohol use early in pregnancy is important to avoid adverse fetal outcomes. Unfortunately, the diagnosis of FAS and FAE is usually made after birth, when alcohol damage has become irreversible and permanent. The clinical laboratory can help prevent this damage and make a valuable contribution in assessing prenatal alcohol use. The clinical utility of blood/breath alcohol, γGT, MCV, HAA and CDT in alcohol use identification, especially in pregnancy, is substantial. Although none of the markers singularly has adequate sensitivity and specificity for screening, their diagnostic utility increases when measured as a panel. This is especially true in detecting alcohol use in pregnancy where the presence of several positive markers was correlated with the presence of alcohol-related fetal effects.