@article{ref1,
title="DOVER and QUVER-New Marker Combinations to Detect and Monitor At-risk Drinking",
journal="Alcoholism: clinical and experimental research",
year="2006",
author="Berner, Michael M. and Bentele, Michael and Kriston, Levente and Mänz, Constantin and Clement, Hans-Willi and Härter, Martin and Mundle, Gotz",
volume="30",
number="8",
pages="1372-1380",
abstract="At-risk drinking is a common medical problem. &quot;Objective&quot; laboratory tests are widely used, especially in situations where it might be favorable for the patient to dissimulate the existing alcohol problem. In this study, we report a new approach to combine the biological markers % carbohydrate-deficient transferrin (%CDT) and gamma-glutamyltransferase (gammaGT) to increase diagnostic properties to identify patients with at-risk drinking behavior. Fifty-eight general practitioners (GPs) participated in the study at 2 study sites in South-West Germany. Patients filled in a questionnaire that included the Alcohol Use Disorders Identification Test (AUDIT) and gave a blood sample. The GP recorded his assessment about the presence of an alcohol-related disorder in the patient. Screening results of 1 test center were used as a calculation sample. The results at the other site were used to cross-validate the study outcomes. The markers were combined by 2 methods. The first approach used the AUDIT (QUestionnaire VERified; QUVER), and the second was performed using the clinical judgment of the treating GP (DOctor VERified; DOVER). The formulas were calculated using linear and logistic regression models, respectively. A total of 2,940 patients participated in the study, of whom 2,496 completed data sets that could be used for further analysis. In the receiver-operating characteristics (ROC) curves with the reference standard of an AUDIT>/=8, the area under the curve (AUC) of 78.8% for DOVER and 80.6% (QUVER) are in a higher range than the values for gamma-%CDT (75.4%) or gamma-GT (66.3%) and %CDT (74.3%) and suggest a clear superiority of the proposed marker combinations. Regarding the combinations DOVER and QUVER, the cross-validation results were almost identical, with 78.4/78.8% and 80.6/79.5%, respectively. Our study is to date the largest practice-based trial that examines the value of the markers CDT and gamma-GT and their combinations for the screening of at-risk drinking in general practice under routine conditions. Our ROC analysis clearly demonstrated that the combination of the markers gamma-GT and %CDT under routine conditions with a behaviorally oriented reference standard leads to an improvement of diagnostic performance, more so than the use of single markers.<p /> <p>Language: en</p>",
language="en",
issn="0145-6008",
doi="10.1111/j.1530-0277.2006.00163.x",
url="http://dx.doi.org/10.1111/j.1530-0277.2006.00163.x"
}