Diagnostics & Screening

Appropriate screenings for unhealthy alcohol use, binge drinking, and alcohol use disorder
- Alcohol Use Disorders Inventory Test (AUDIT)
- AUDIT-C (questions 1-3 of AUDIT)
Biomarkers of alcohol use can be found in urine, hair, or blood
- NOT recommended to use as tools to “catch” people à open the floor for discussion
- Patients should always consent to testing

Laboratory Values

Liver Related Enzymes

Laboratory Test

Description

Key Points

Aminotransferases

(AST/ALT)

-Produced in hepatocytes

-Indicates hepatocellular injury

-Rapidly changing

-Inadequate to establish alcohol use

-AST:ALT ratio > 1 may indicate cirrhosis 2/2 alcohol

Gamma-glutamyl transferase

(GGT)

-Enzyme found in cell membranes in spleen and liver tissues

–

-Frequently elevated in heavy drinking

-Greater sensitivity than AST for cirrhosis

-Not specific for alcohol use

Bilirubin

-Created through degradation of several heme-containing proteins

-Non-specific to liver disease

-Elevations occur in 1later disease, and may indicate more severe cirrhosis

–

Additional Labs
Laboratory Test	Description	Key Points
Albumin	-Produced by the liver in hepatocytes, accounts for 10% of liver protein production daily -Provides oncotic pressure in plasma -Indicator of nutritional status	-Lower albumin carries an overall negative prognosis (cirrhosis + other disease states) -Should not be supplemented externally (ALBIOS, ATTIRE) for sake of repletion
INR	-Prothrombin time compared to a laboratory normative prothrombin time -Designed with vitamin-k antagonists in mind	-NOT an indication of bleed risk -Patients may be in a hypercoagulable state despite elevated INR
Platelets	-Synthesized by the liver -Improved prognostic factor for bleeding when compared to INR	-Can be used as a biomarker for cirrhosis severity, not validated, taking trend and baseline into account