Serum Aspartate Aminotransferase, Alanine Aminotransferase, and Gamma-Glutamyl Transferase as Biomarkers of Active Alcohol Use and Abstinence in Indian Patients with Alcohol Dependence Syndrome: A Retrospective Study

A BSTRACT Background: Monitoring alcohol abstinence is challenging due to the limitations of self-reporting. This study aimed to establish diagnostic cut-offs for serum biomarkers – aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) – to detect active alcohol consumption and monitor abstinence in Indian patients with alcohol dependence syndrome (ADS). Methodology: A retrospective chart review was conducted on 316 patients diagnosed with ADS. Exclusion criteria included co-morbid substance dependence (excluding nicotine), chronic medical conditions, or ongoing treatment for other systemic illnesses. Results: Mean patient age was 37.6 years, and 47% had co-morbid nicotine dependence. Receiver-operating characteristic analysis yielded area under curve values of 0.821 (AST), 0.841 (ALT), and 0.990 (GGT). At a cutoff of 81.0 U/L, GGT demonstrated the highest sensitivity (83.7%) and specificity (98.9%) for detecting active consumption. Optimal cutoffs for AST (101.5 U/L) and ALT (80.0 U/L) showed high specificities (98.9% and 96.7%, respectively). Following abstinence, ALT was the earliest to normalize, followed by AST and GGT. A paradoxical 48-h rise in transaminases was observed during early detoxification before levels began to decline. Conclusion: GGT is a superior tool for screening active alcohol consumption and monitoring long-term abstinence, whereas AST and ALT are better suited for monitoring short-term recovery. These findings provide essential clinical thresholds for the Indian population, although multicentric prospective studies are required for broader generalizability.