Alcohol misuse: laboratory markers (identification and follow-up, outside withdrawal)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Misuse identified (AUDIT-C): initial tests
Laboratory tests
- FBC (MCV, platelets)
- PT
- AST
- ALT
- GGT
- Carbohydrate-deficient transferrin (CDT) (diagnostic doubt, ambivalent patient)if neededTo document regular excessive drinking in an ambivalent patient or when GGT is poorly specific; more specific than GGT (80 to 90%), half-life about 15 days [2].
- Hepatitis B serologyif neededRisk factor (drug use, especially intravenous, unprotected sex) or raised transaminases, especially predominantly ALT; screen at least once in a lifetime according to the AFEF (French Association for the Study of the Liver) [2].
- Hepatitis C serologyif neededRisk factor (drug use, especially intravenous, unprotected sex) or raised transaminases, especially predominantly ALT; screen at least once in a lifetime according to the AFEF (French Association for the Study of the Liver) [2].
- HIV serology (risk factor, with the patient's consent)if neededOffer according to risk factors, with the patient's consent [2].
- FibroTest® (age 40-45 or over, abnormal AUDIT or 14 drinks a week or more; if elastography is not available)if neededScreening for advanced alcohol-related liver disease with a non-invasive test (Fibroscan®, FibroTest® or FibroMètre Alcool®) in people aged 40-45 or over with a pathological AUDIT or drinking ≥ 14 drinks per week [2].
- Non-laboratory alternative to the blood score: transient elastography (Fibroscan®).
Also consider
- Planned withdrawal? If withdrawal is planned, see the page "Outpatient alcohol withdrawal".
- Raised GGT? If GGT is raised, see the page "Isolated raised GGT".
Do not order
- GGT, MCV or CDT to detect alcohol misuse in an untargeted population: too insensitive, the biological markers become positive late; detection relies on the AUDIT-C [2]
- ALT alone to screen for advanced alcohol-related liver disease: poor performance; go straight to a non-invasive test [2]
- APRI to assess fibrosis in alcohol-related liver disease: insufficient performance, not recommended (AFEF-SFA) [5]
- Ethyl glucuronide or phosphatidylethanol to detect drinking in the general population: insufficient data [5]
Follow-up (reduction or abstinence)
Laboratory tests
- GGT (to monitor progress)
- Carbohydrate-deficient transferrin (CDT) (if raised at baseline)if neededFollow-up of an initially raised CDT: half-life about 15 days; more specific than GGT [2].
- FBCif neededAssessment of complications at least once a year during outpatient follow-up [2].
- PTif neededAssessment of complications at least once a year during outpatient follow-up [2].
- ASTif neededAssessment of complications at least once a year during outpatient follow-up [2].
- ALT (at least once a year)if neededAssessment of complications at least once a year during outpatient follow-up [2].
- PTif neededNaltrexone in a patient with non-severe alcohol-related liver disease, including compensated cirrhosis: monthly laboratory monitoring (PT, transaminases) [2].
- ASTif neededNaltrexone in a patient with non-severe alcohol-related liver disease, including compensated cirrhosis: monthly laboratory monitoring (PT, transaminases) [2].
- ALT every month (naltrexone and alcohol-related liver disease)if neededNaltrexone in a patient with non-severe alcohol-related liver disease, including compensated cirrhosis: monthly laboratory monitoring (PT, transaminases) [2].
- Serum electrolytesif needednon-French guidelineBefore treatment with acamprosate, naltrexone or disulfiram: NICE (UK) asks for baseline urea, electrolytes and liver function tests (including GGT) [7]; the Australian guidelines suggest assessing renal function before acamprosate, which is 90% eliminated by the kidney [8]. The SFA (French Society of Alcohology) recommendation does not provide for renal tests before these drugs [2]. Baseline liver function tests are already part of the initial tests.
- Serum creatinineif needednon-French guidelineBefore treatment with acamprosate, naltrexone or disulfiram: NICE (UK) asks for baseline urea, electrolytes and liver function tests (including GGT) [7]; the Australian guidelines suggest assessing renal function before acamprosate, which is 90% eliminated by the kidney [8]. The SFA (French Society of Alcohology) recommendation does not provide for renal tests before these drugs [2]. Baseline liver function tests are already part of the initial tests.
Sources (9)
- Andler R, Quatremère G, Gautier A, Nguyen-Thanh V, Beck F. Consommation d'alcool : part d'adultes dépassant les repères de consommation à moindre risque à partir des données du Baromètre de Santé publique France 2021. Bull Epidémiol Hebd. 2023;(11), 13 juin 2023.
- Société française d'alcoologie. Mésusage de l'alcool : dépistage, diagnostic et traitement. Recommandation de bonne pratique (méthode RPC), 9 février 2015, actualisée le 5 juin 2023.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0779 (transferrine désialylée, CDT) et 1000 à 1002 (scores biologiques de fibrose hépatique : FibroTest®, FibroMètre V®, Hepascore).
- Haute Autorité de santé. Diagnostic de la dénutrition de l'enfant et de l'adulte. Recommandation de bonne pratique, novembre 2019.
- Association française pour l'étude du foie (AFEF), Société française d'alcoologie (SFA). Prise en charge de la maladie du foie liée à l'alcool. Recommandations, janvier 2021.
- US Preventive Services Task Force. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. Final Recommendation Statement, 13 novembre 2018 (grade B chez l'adulte ; mise à jour en cours).
- National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. Clinical guideline CG115, février 2011 (mise à jour octobre 2014).
- Haber PS, Riordan BC. Guidelines for the Treatment of Alcohol Problems (4th edition). Sydney : Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, 2021 (préparé pour l'Australian Government Department of Health). ISBN 978-1-74210-489-9.
- National Institute for Health and Care Excellence. Cirrhosis in over 16s: assessment and management. NICE guideline NG50, juillet 2016 (mise à jour septembre 2023), recommandations 1.1 et guide complet de juillet 2016 (chapitre « Risk factors and risk assessment tools »).