An important goal of clinical medicine and forensic toxicology is to identify appropriate biomarkers of ethanol consumption to objectively support the diagnosis of chronic excessive alcohol intake. Commonly, screening of large population sets are executed by inexpensive determination of indirect biomarkers. The present study proposes a multivariate strategy based on five indirect biomarkers (AST, ALT, γ-GT, MCV and CDT), capable of considerably enhancing their individual diagnostic efficiency, specificity and sensitivity. Blood samples were collected from 240 healthy non-alcohol abusers and other 183 subjects, classified as non-drinkers, social drinkers and active heavy drinkers. ROC curves were determined on original biomarkers and mathematical combinations of them to provide an evaluation of their diagnostic performances in terms of discrimination between healthy non-alcohol abusers and heavy drinkers. The results from these univariate approaches were compared with those of the UNEQ class modeling multivariate strategy. The outcomes show that the multivariate approach can noticeably improve the screening potential of indirect biomarkers in the evaluation of alcohol misuse, with respect to the univariate strategy, and can be easily introduced in the clinical routine work. Only a moderate percentage of subjects (10%÷20%, at a fixed 10% or 5% misrecognition rate of heavy drinkers) is requested to undergo more expensive and time-demanding confirmation procedures, with a consistent reduction of work and expenses. The improved capability of the multivariate evaluation makes the reappraisal of indirect biomarkers topical, in contrast with the recent trend of considering their use void of practical significance.
Multivariate Strategies for screening evaluation of chronic alcohol abuse
PIRRO, VALENTINA;A. Salomone;VINCENTI, Marco
2012-01-01
Abstract
An important goal of clinical medicine and forensic toxicology is to identify appropriate biomarkers of ethanol consumption to objectively support the diagnosis of chronic excessive alcohol intake. Commonly, screening of large population sets are executed by inexpensive determination of indirect biomarkers. The present study proposes a multivariate strategy based on five indirect biomarkers (AST, ALT, γ-GT, MCV and CDT), capable of considerably enhancing their individual diagnostic efficiency, specificity and sensitivity. Blood samples were collected from 240 healthy non-alcohol abusers and other 183 subjects, classified as non-drinkers, social drinkers and active heavy drinkers. ROC curves were determined on original biomarkers and mathematical combinations of them to provide an evaluation of their diagnostic performances in terms of discrimination between healthy non-alcohol abusers and heavy drinkers. The results from these univariate approaches were compared with those of the UNEQ class modeling multivariate strategy. The outcomes show that the multivariate approach can noticeably improve the screening potential of indirect biomarkers in the evaluation of alcohol misuse, with respect to the univariate strategy, and can be easily introduced in the clinical routine work. Only a moderate percentage of subjects (10%÷20%, at a fixed 10% or 5% misrecognition rate of heavy drinkers) is requested to undergo more expensive and time-demanding confirmation procedures, with a consistent reduction of work and expenses. The improved capability of the multivariate evaluation makes the reappraisal of indirect biomarkers topical, in contrast with the recent trend of considering their use void of practical significance.
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