Forensic aspects of postmortem serum carbohydrate-deficient transferrin analysis as a marker of alcohol abuse

Introduction. Carbohydrate-deficient transferrin (CDT) has been suggested as one of alcohol abuse indicators having produced good results in forensic medicine for years. Objective. The aim of the study was to identify correlation between present methodology of alcohol abuse diagnosis at autopsy (macroscopic and microscopic findings) and CDT examination using the method of isoelectrofocusing (IEF) in polyacrylamide gel electrophoresis (PAGE). We also analyzed if the time interval between the moment of death and blood sample collection influences CDT findings. Methods The method used for CDT analysis was IEF-PAGE. Sera of 49 males and 11 females aged 14-87 years, average age 46.85±18.53, were used in this study. Control group consisted of five patients who died after medical treatment that lasted longer than 15 days, and five patients who started Disulfiram therapy in controlled hospital environment. Results. The results obtained in CDT examination in dead bodies' sera showed sensitivity 59% and specificity 71%. A high incidence of falsely positive CDT result was noticed in liver failure and cirrhosis of non-alcoholic origin. CDT analysis is also possible to be done in samples collected postmortem up to 76 hours. Conclusion. In forensic medicine, the method of CDT determination is reliable for the diagnosis of alcohol abuse.
Uvod. Poslednjih godina transferin s nedostatkom ugljenih hidrata (engl. carbohydrate-deficient transferrin - CDT) jedan je od markera zloupotrebe alkohola koji je pokazao najbolje rezultate u sudskoj medicini. Cilj rada. Cilj studije je bio da se odredi korelacija između aktuelne metodologije dijagnoze zloupotrebe alkohola na postmortalnom materijalu (makroskopski i mikroskopski nalaz) i određivanja CDT korišćenjem metode isoelektrofokusiranja (engl. isoelectric focusing - IEF) u poliakrilamidnom gelu (engl. polyacrylamide gel electrophoresis - PAGE). Utvrđivano je da li interval između vremena smrti i uzimanja uzoraka za CDT analizu utiče na nalaz CDT. Metode rada. Za analizu CDT korišćena je metoda IEF-PAGE. Za studiju su analizirani serumi 49 muškaraca i 11 žena prosečne starosti od 46,85±18,53 godina (raspon 14-87 godina). Kontrolnu grupu činilo je pet pacijenata koji su umrli nakon bolničkog lečenja koje je trajalo duže od 15 dana i pet pacijenata kod kojih je u kontrolisanim bolničkim uslovima počelo lečenje disulfiramom. Rezultati. Dobijeni rezultati pokazuju da ova metoda analize CDT na postmortalnom materijalu ima senzitivnost od 59% i specifičnost od 71%. Visoka učestalost lažno pozitivnih rezultata utvrđena je kod oboljenja jetre i ci- roze nealkoholnog porekla. Analizu CDT je moguće raditi i iz uzoraka uzetih do 76 sati nakon smrti. Zaključak. U sudskomedicinskoj praksi ova metoda analize CDT može se koristiti za dijagnostikovanje hronične zloupotrebe alkohola.