Alcoholism: Likelihood Ratios

Introduction: Alcoholism is a disease "characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortion of thinking, most notably denial".

Alcohol abuse = a maladaptive pattern of use associated with one or more of the following:

Failure to fulfill work, school, or social obligations

Recurrent substance use in physically hazardous situations

Recurrent legal problems related to substance use

Continued use despite alcohol-related social or interpersonal problems

Alcohol dependence = maladaptive pattern of use associated with three or more of the following:

Tolerance

Withdrawal

Substance taken in larger quantity than intended

Persistent desire to cut down or control use

Time is spent obtaining, using, or recovering from the substance

Social, occupational, or recreational tasks are sacrificed

Use continues despite physical and psychological problems

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Tags: Hepatic Psychiatric Toxic Tag this Diagnosis.

Differential Diagnoses include: Nonalcoholic Steatohepatitis

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Primary Care	5%	Ann Intern Med 2004 Apr 6;140(7):554-6. PMID 15068984
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The likelihood ratios of findings for Alcoholism are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Elevated AST	+ 0 -	2.8	0.6
Study: See table in: http://www.utdol.com/online/content/topic.do?topicKey=hep_dis/7556 From Alcohol Clin Exp Res 1994 Oct;18(5):1103-8. and Arch Intern Med 1995 Sep 25;155(17):1907-11.
[ + ] Increased MCV	+ 0 -	2.7	0.7
i.e. mean corpuscular volume Study: See table in: http://www.utdol.com/online/content/topic.do?topicKey=hep_dis/7556 From Alcohol Clin Exp Res 1994 Oct;18(5):1103-8. and Arch Intern Med 1995 Sep 25;155(17):1907-11.
[ + ] Elevated ALT	+ 0 -	2.5	0.8
Study: See table in: http://www.utdol.com/online/content/topic.do?topicKey=hep_dis/7556 From Alcohol Clin Exp Res 1994 Oct;18(5):1103-8. and Arch Intern Med 1995 Sep 25;155(17):1907-11.

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] CAGE Questionnaire	+ 0 -	8.2	0.3
>=2 questions positive: Have you ever felt the need to Cut down on drinking? Have you ever felt Annoyed by criticism of your drinking? Have you ever had Guilty feelings about your drinking? Do you ever take a morning Eye opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)? Study: Ann Intern Med 1991 Nov 15;115(10):774-7. PMID 1929025
[ + ] Elevated Carbohydrate-Deficient Transferrin	+ 0 -	4.3	0.4
Study: See table in: http://www.utdol.com/online/content/topic.do?topicKey=hep_dis/7556 From Alcohol Clin Exp Res 1994 Oct;18(5):1103-8. and Arch Intern Med 1995 Sep 25;155(17):1907-11.
[ + ] Elevated GGT	+ 0 -	2.3	0.4
Study: See table in: http://www.utdol.com/online/content/topic.do?topicKey=hep_dis/7556 From Alcohol Clin Exp Res 1994 Oct;18(5):1103-8. and Arch Intern Med 1995 Sep 25;155(17):1907-11.
[ + ] AST > ALT	+ 0 -	16.7	0.5
ratio >2.0 both usually <300 IU/L, and almost never >500 IU/L Differential Diagnosis: Nonalcoholic Steatohepatitis Study: (data back-calculated from the corresponding data for NASH by AST/ALT <= 2) Am J Gastroenterol. 1999 Apr;94(4):1018-22. PMID 10201476