Diagnostic utility of hematologic, biochemical, and imaging investigations in alcohol dependence: A case–control study

Background: The relationship between drinking severity and liver biochemical markers, USG, and FibroScan has not been adequately examined in Alcohol Dependence Syndrome (ADS) patients. Aim: To estimate the prevalence of macrocytosis in patients with ADS versus age-matched controls and examine its association with folate, vitamin B12, and vitamin D levels, liver biochemical markers, and imaging findings. Materials and Methods: This retrospective, case–control study included 47 ADS patients and 50 age-matched controls. MCV, vitamin B12, vitamin D, folic acid, GGT, AST, and ALT. USG and FibroScan were recorded for ADS patients. ADS cases were stratified into moderate and excessive drinkers. Statistical tests included the Mann–Whitney U test and the chi-square test. Results: ADS patients had significantly higher MCV, with macrocytosis in 44.7% compared to 8.0% in controls. Folic acid was significantly lower in ADS. Vitamins D and B12 showed no significant differences. GGT, AST, and ALT were all elevated ( P < 0.001). Excessive drinkers had higher GGT levels ( P = 0.02), but no differences were observed in MCV, FibroScan, or vitamin levels. GGT performed as a robust marker distinguishing cases from controls and excessive from moderate drinkers. ALT emerged as the most accurate single marker for alcohol dependence diagnosis in this low-prevalence setting. Conclusion: In ADS patients, macrocytosis was common and strongly associated with alcohol-related markers and low folate. These findings support routine folate screening and appropriate nutritional interventions in ADS patients, highlighting the role of ALT, GGT, and liver imaging in clinical evaluation.