Usefulness of indirect alcohol biomarkers for predicting recidivism of drunk-driving among previously convicted drunk-driving offenders: results from the Recidivism Of Alcohol-impaired Driving (ROAD) study.

BIOMARKERS; CONFIDENCE intervals; CRIMINALS; EPIDEMIOLOGY; ETHANOL; RECIDIVISTS; STATISTICAL sampling; SURVIVAL analysis (Biometry); TRAFFIC accidents; TRANSFERASES; U-statistics; LOGISTIC regression analysis; DATA analysis; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; ALCOHOLIC intoxication

Aim In several European countries, drivers under the influence ( DUI), suspected of chronic alcohol abuse are referred for medical and psychological examination. This study (the ROAD study, or Recidivism Of Alcohol-impaired Driving) investigated the usefulness of indirect alcohol biomarkers for predicting drunk-driving recidivism in previously convicted drunk-driving offenders. Design, setting, participants and measurements The ROAD study is a prospective study (2009-13) that was performed on 517 randomly selected drivers in Belgium. They were convicted for drunk-driving for which their licence was confiscated. The initial post-arrest blood samples were collected and analysed for percentage carbohydrate-deficient transferrin (% CDT), transaminsase activities [alanine amino transferase ( ALT), aspartate amino transferase ( AST)], gamma-glutamyltransferase (γ GT) and red cell mean corpuscular volume ( MCV). The observation time for each driver was 3 years and dynamic. Findings A logistic regression analysis revealed that ln(% CDT) ( P < 0.001), ln(γ GT) ( P < 0.01) and ln( ALT) ( P < 0.05) were the best biochemical predictors of recidivism of drunk-driving. The ROAD index (which includes ln(% CDT), ln(γ GT), -ln( ALT) and the sex of the driver) was calculated and had a significantly higher area under the receiver operator characteristic curve (0.71) than the individual biomarkers for drunk-driving recidivism. Drivers with a high risk of recidivating ( ROAD index ≥ 25%; third tertile) could be distinguished from drivers with an intermediate risk (16% ≤ ROAD index < 25%; second tertile; P < 0.001) and a low recidivism risk ( ROAD index < 16%; first tertile ; P < 0.05). Conclusions Of all routinely used indirect alcohol markers, percentage of carbohydrate-deficient transferrin is the major predictor of recidivism of drunk-driving. The association with gamma-glutamyltransferase, alanine amino transferase and the sex of the driver could have additional value for identifying drunk-drivers at intermediate risk of recidivism. Non-specific indirect alcohol markers, such as alanine amino transferase, gamma-glutamyltransferase, aspartate amino transferase and red cell mean corpuscular volume have minimal added value to % carbohydrate-deficient transferrin for distinguishing drunk drivers with a low or high risk of recidivism. [ABSTRACT FROM AUTHOR]

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