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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
  • [Edit Diagnosis] [Merge dx] [Add prevalence]

    Tags: Hepatic Psychiatric Toxic Tag this Diagnosis.

    Differential Diagnoses include: Nonalcoholic Steatohepatitis

    Prevalence

    Population / CalculatorPrevalence Comments / Study / Link
    Primary Care 5% Ann Intern Med 2004 Apr 6;140(7):554-6. PMID 15068984
    More, Edit...

    The likelihood ratios of findings for Alcoholism are listed below. See the left navigation bar to change the display.

    Good Positive and Negative Likelihood Ratios

    Finding +LR-LR Comments, Study
    CAGE Questionnaire Edit 8.20.3

    >=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 Edit 4.30.4

    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 Edit 2.30.4

    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 Edit 16.70.5

    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

    Good Positive Likelihood Ratio

    Finding +LR-LR Comments, Study
    Elevated AST Edit 2.80.6

    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 Edit 2.70.7

    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 Edit 2.50.8

    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.