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Alcohol. 2018 Feb;66:1-7. doi: 10.1016/j.alcohol.2017.07.006. Epub 2017 Sep 23.

Evaluation of laboratory tests for cirrhosis and for alcohol use, in the context of alcoholic cirrhosis.

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Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Queensland 4029, Australia. Electronic address:
Faculty of Medical Sciences, Newcastle University Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, USA.
Centenary Institute of Cancer Medicine and Cell Biology, Camperdown, NSW 2050, Australia.
Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Zeppelinstraße 11-33, 69121 Heidelberg, Germany.
NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
Division of Clinical Toxicology, Department of Internal Medicine, 2 Klinikum rechts der Isar School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
The Clinical Research Facility, O Floor, The Royal Hallamshire Hospital, Glossop Road, S10 2JF, United Kingdom.
Wolfson Centre for Personalised Medicine, Molecular & Clinical Pharmacology, University of Liverpool, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom.
Gastroenterology and Hepatology, University Hospital Zurich, Ramistrasse 100, CH-8901 Zurich, Switzerland.
Privatklinik Meiringen, Willigen, CH 3860 Meiringen, Switzerland.
Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, United Kingdom.
Service Addictologie, CHRU Caremeau, 30029 Nîmes, France; DISC, Inserm, 75013 Paris, France.
CHRU de LILLE - Hôpital Claude Huriez, Rue M. Polonovski - CS 70001, 59 037 Lille Cedex, France.
Centre Hospitalier Universitaire de Montpellier, Département des maladies infectieuses et tropicales, Montpellier, France.
CHU de Rennes, Unité d'Addictologie, F-35033 Rennes, France.
APHP, Liver Unit, Hospital Jean Verdier, Bondy, France; University Paris 13, Bobigny, France; Inserm U1162 "Functional Genomics of Solid Tumors", Paris, France.
HU-Paris Sud, 157 Rue de la Porte de Trivaux, 92140 Clamart, France.
Hôpital Universitaire Carémeau, Place du Pr. Robert Debré, 30029 Nîmes, France.
Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.
Drug Health Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia.
Department of Veterans Affairs, VA Long Beach Healthcare System, 5901 East Seventh Street, Long Beach, CA 90822, USA.
Centenary Institute of Cancer Medicine and Cell Biology, Camperdown, NSW 2050, Australia; Drug Health Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address:


Laboratory tests can play an important role in assessment of alcoholic patients, including for evaluation of liver damage and as markers of alcohol intake. Evidence on test performance should lead to better selection of appropriate tests and improved interpretation of results. We compared laboratory test results from 1578 patients between cases (with alcoholic cirrhosis; 753 men, 243 women) and controls (with equivalent lifetime alcohol intake but no liver disease; 439 men, 143 women). Comparisons were also made between 631 cases who had reportedly been abstinent from alcohol for over 60 days and 364 who had not. ROC curve analysis was used to estimate and compare tests' ability to distinguish patients with and without cirrhosis, and abstinent and drinking cases. The best tests for presence of cirrhosis were INR and bilirubin, with areas under the ROC curve (AUCs) of 0.91 ± 0.01 and 0.88 ± 0.01, respectively. Confining analysis to patients with no current or previous ascites gave AUCs of 0.88 ± 0.01 for INR and 0.85 ± 0.01 for bilirubin. GGT and AST showed discrimination between abstinence and recent drinking in patients with cirrhosis, including those without ascites, when appropriate (and for GGT, sex-specific) limits were used. For AST, a cut-off limit of 85 units/L gave 90% specificity and 37% sensitivity. For GGT, cut-off limits of 288 units/L in men and 138 units/L in women gave 90% specificity for both and 40% sensitivity in men, 63% sensitivity in women. INR and bilirubin show the best separation between patients with alcoholic cirrhosis (with or without ascites) and control patients with similar lifetime alcohol exposure. Although AST and GGT are substantially increased by liver disease, they can give useful information on recent alcohol intake in patients with alcoholic cirrhosis when appropriate cut-off limits are used.


Abstinence; Alcohol; Aspartate aminotransferase; Cirrhosis; Gamma glutamyl transferase

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