Biologic Markers Key Points

• The AST level is higher than the ALT level.

• There is a positive response to CDT level.

• Five drinks daily for 2 weeks elevates GGT in most people.

• Using GGT and CDT in combination increases sensitivity over either marker alone by 20% without compromising specificity.

Diagnostic clues from the laboratory include a complete blood count (CBC) with an elevated mean cell volume, elevated y-glutamyltransferase (GGT), aspartate transaminase (AST) level higher than alanine transaminase (ALT), unexplained leukopenia or thrombocytopenia, and positive response to the carbohydrate-deficient transferrin (CDT) level (Borg et al., 1992). It is estimated that 5 drinks/day for two weeks will yield an elevated GGT in most people (USDHHS, SAMSHA, 2006). Using CDT and GGT together increases

Box 49-3 TWEAK Screening For Alcohol Use

TWEAK is a five-item scale developed originally to screen for risk drinking during pregnancy.


(1-2) Tolerance: How many drinks can you hold? or How many drinks do you need to feel high?

(1-2) Worried: Have close friends or relatives worried or complained about your drinking in the past year?

(1) Eye-openers: Do you sometimes take a drink in the morning when you first get up?

(1) Amnesia (blackouts): Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?

(1) Cut down: Do you sometimes feel the need to cut down on your drinking?

Administering and Scoring

Before administering TWEAK, drinkers are identified by a positive response to the question, "Do you consume, or have you ever consumed, beer, wine, wine coolers, or drinks containing liquor (i.e., whiskey, rum, or vodka)?" To score the test, a 7-point scale is used.

The "tolerance-hold" question scores 2 points if the respondent is able to hold six or more drinks.

The "tolerance-high" question scores 2 points if three or more drinks are needed to feel high.

A total score of 2 or more indicates that obstetric patients are likely to be risk drinkers. However, preliminary studies suggest that cutoff points of 3 or 4 are better than 2 for identifying harmful drinking or alcoholism.

sensitivity by 20% of either marker alone without compromising specificity (Hitela et al., 2006). Dose-response relationships are not well established, making it difficult to use these tests as a direct quantifier for alcohol consumption (Allen et al., 2004).

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