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Favrod-Coune T, Lidsky D, Vionnet J, Magini G, Déglon J, Broers B. A false positive hair ethylglucuronide dosage in an alcohol abstinent patient after liver transplantation: a case report. Front Med (Lausanne) 2024; 11:1363012. [PMID: 38633301 PMCID: PMC11021601 DOI: 10.3389/fmed.2024.1363012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
The use of direct alcohol biomarkers (ethylglucuronide and phosphatidylethanol) has recently been implemented in a clinical setting. Due to their low alcohol detection threshold, high sensitivity, and specificity, these tools are very useful in the pre- and post-liver transplantation setting, where the history and physical signs are not always reliable. However, the interpretation of the results can sometimes be misleading and must be integrated into a global clinical evaluation and, more importantly, in the clinical context of each patient. We present here a case report illustrating a false-positive hair ethylglucuronide caused by the application of a capillary gel in an abstinent patient after liver transplantation. This reminds us that even the most accurate laboratory tests must be interpreted with caution.
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Affiliation(s)
| | - Déborah Lidsky
- Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Julien Vionnet
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Giulia Magini
- Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Julien Déglon
- Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Barbara Broers
- Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
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2
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Triolo V, Spanò M, Buscemi R, Gioè S, Malta G, Čaplinskiene M, Vaiano F, Bertol E, Zerbo S, Albano GD, Argo A. EtG Quantification in Hair and Different Reference Cut-Offs in Relation to Various Pathologies: A Scoping Review. TOXICS 2022; 10:toxics10110682. [PMID: 36422890 PMCID: PMC9696213 DOI: 10.3390/toxics10110682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/02/2023]
Abstract
Ethyl glucuronide (EtG) is a non-volatile, non-oxidative, hydrophilic, and stable ethanol phase II metabolite. EtG is produced through ethanol glucuronidation by UDP-glucuronosyltransferase (UGT), a phase II enzyme. EtG can be extracted from different biological matrices, including keratin ones, such as hair or nails. The purpose of this scoping review is to describe the relationship between EtG levels in hair and some of the most common and frequent pathological conditions and verify whether different reference cut-offs in relation to various pathologies have been identified in the scientific literature. In fact, in-depth knowledge of the influence of pathologies, such as diabetes mellitus, hepatic and renal dysfunction, on EtG production and its storage in keratin matrices would allow a more appropriate interpretation of obtained data and rule out false positives or false negatives. This scoping review is based on bibliographic research carried out on PubMed regarding the quantification of EtG in hair of subjects affected by different pathological conditions. According to the scientific literature, the main and most common pathologies that can affect the concentration of EtG in hair are liver and kidney diseases and diabetes. The EtG quantification analytical data should be interpreted carefully as they may have a great impact in both forensic and clinical contexts.
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Affiliation(s)
- Valentina Triolo
- Policlinic Hospital, AOUP “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
| | - Mario Spanò
- Policlinic Hospital, AOUP “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Roberto Buscemi
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Simona Gioè
- Policlinic Hospital, AOUP “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
| | - Ginevra Malta
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Marija Čaplinskiene
- State Forensic Medicine Service, Mykolas Romeris University, Ateities St. 20, LT-08303 Vilnius, Lithuania
| | - Fabio Vaiano
- Forensic Toxicology Division, Department of Health Sciences, University of Firenze, 50134 Firenze, Italy
| | - Elisabetta Bertol
- Forensic Toxicology Division, Department of Health Sciences, University of Firenze, 50134 Firenze, Italy
| | - Stefania Zerbo
- Policlinic Hospital, AOUP “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Giuseppe Davide Albano
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Antonina Argo
- Policlinic Hospital, AOUP “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
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3
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Nielsen DG, Andersen K, Nielsen AS, Nielsen F, Behrendt S, Bilberg R, Bogenschutz M, Bühringer G, Mellentin AI. Comparison of self-reported alcohol consumption and ethyl glucuronide in hair in a sample of 60+ year -olds treated for DSM-5 alcohol use disorder. Addict Biol 2022; 27:e13231. [PMID: 36301220 PMCID: PMC9786874 DOI: 10.1111/adb.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023]
Abstract
There is a lack of evidence for the consistency between self-reported alcohol consumption (SRAC) and concentrations of ethyl glucuronide in hair (hEtG) among elderly patients treated exclusively for alcohol use disorder (AUD). Hence, this study assessed the consistency between these two measures in these patients. A total of 190 patients with AUD were assessed for SRAC using Form 90 and hEtG, 14 or 22 weeks after treatment conclusion. Patients were grouped according to SRAC (g/day) and corresponding hEtG concentrations (pg/mg): 0 and <5 (abstinence), 0.1-14.3 and 5.0-9.9 (low consumption), 14.4-21.4 and 10.0-15.9 (moderate consumption), 21.5-59.9 and 16.0-30 (high consumption) and ≥60 and >30 (excessive consumption). The extent of underreporting and overreporting was examined by crosstabulations, and inter-rater reliability was reported by kappa correlations. Associations and effect modification were examined by conditional logistic regression. Due to multitesting, p-values ≤0.01 were considered significant. Underreporting was found in 96 patients (50.5%) and overreporting in 41 patients (21.6%). The kappa coefficients varied between 0.19 and 0.34. HEtG was more likely to detect low, moderate and high alcohol consumption compared with SRAC (ORs between 5.1 and 12.6, all p-values <0.01), but SRAC and hEtG did not differ significantly with respect to identification of abstinence (OR = 1.9, p = 0.05). Inconsistency between the outcome measures was found in a considerable number of the patients. More studies examining the consistency between SRAC and specific direct biomarkers of alcohol in this population seem warranted.
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Affiliation(s)
- Dorthe Grüner Nielsen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Kjeld Andersen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Open, Odense Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Flemming Nielsen
- Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Silke Behrendt
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Institute for PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Randi Bilberg
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Michael Bogenschutz
- NYU Grossman School of MedicineNew York CityNew YorkUSA,Health Sciences CenterUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Gerhard Bühringer
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,IFT Institut für TherapieforschungMunichGermany
| | - Angelina Isabella Mellentin
- Unit for Clinical Alcohol Research, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,BRIDGE, Brain Research, Inter‐Disciplinary Guided Excellence, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Tele‐Psychiatric Center, Region of Southern DenmarkOdenseDenmark
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4
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Staufer K, Huber-Schönauer U, Strebinger G, Pimingstorfer P, Suesse S, Scherzer TM, Paulweber B, Ferenci P, Stimpfl T, Yegles M, Datz C, Trauner M. Ethyl glucuronide in hair detects a high rate of harmful alcohol consumption in presumed non-alcoholic fatty liver disease. J Hepatol 2022; 77:918-930. [PMID: 35605744 DOI: 10.1016/j.jhep.2022.04.040] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/05/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) cannot reliably be distinguished by routine diagnostics, and the role of alcohol consumption in metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. We investigated alcohol consumption in patients with presumed NAFLD and ALD using novel objective alcohol markers. METHODS In total, 184 consecutive patients were included in this prospective observational study. Alcohol intake was assessed by ethylglucuronide in hair (hEtG) and urine (uEtG); the utility of these measures for alcohol detection was compared to Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), carbohydrate deficient transferrin (CDT), mean corpuscular volume (MCV), gamma-glutamyltransferase (GGT), and ALD/NAFLD index (ANI). Clinical characteristics of patients with NAFLD and ALD were re-assessed after reclassification based on repeated moderate (≥10 g <60 g EtOH/day) and excessive (≥60 g EtOH/day) alcohol consumption, and patients were retrospectively reclassified based on MAFLD criteria. RESULTS Repeated moderate to excessive alcohol consumption was detected in 28.6%, 28.5%, and 25.0% of patients with presumed NAFLD, ALD or MAFLD, respectively. ANI score, AUDIT-C, uEtG, and hEtG showed AUCs of 0.628, 0.733, 0.754, and 0.927 for the detection of repeated moderate to excessive alcohol consumption, respectively. The indirect markers CDT, MCV and GGT were not reliable. Patients with repeated moderate or excessive alcohol consumption were significantly more often male, had a significantly lower BMI, and suffered significantly less often from type 2 diabetes or impaired glucose tolerance. CONCLUSIONS In total, 28.6% of patients with presumed NAFLD, and 25.0% with MAFLD are at risk of alcohol-related liver damage. AUDIT-C, uEtG and hEtG should be used to screen for alcohol consumption in patients with fatty liver disease. LAY SUMMARY Fatty liver disease can be caused by metabolic factors and/or alcohol consumption. The diagnosis of non-alcoholic fatty liver disease (NAFLD) is based on the exclusion of harmful alcohol consumption, while metabolic dysfunction-associated fatty liver disease (MAFLD), which has been proposed as a new name for NAFLD, is based on the presence of metabolic comorbidities and allows for alcohol consumption. Herein, we show that up to 29% of patients diagnosed with NAFLD and 25% with MAFLD are at risk of alcohol-related liver damage. We show that ethyl glucuronide (a metabolite of alcohol) in the hair and urine can accurately detect potentially harmful alcohol consumption in these patients - as such, these tests should be integrated into routine diagnostic work-up for patients with fatty liver disease.
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Affiliation(s)
- Katharina Staufer
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria; Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, Krankenhaus Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria
| | - Georg Strebinger
- Department of Internal Medicine, Krankenhaus Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria
| | - Philipp Pimingstorfer
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine 2 for Nephrology, Endocrinology, Rheumatology, and Gastroenterology, Johannes Kepler University Linz, Med Campus III, Linz, Austria
| | | | | | - Bernhard Paulweber
- First Department of Medicine, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Peter Ferenci
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Department of Laboratory Medicine, Division of Toxicology, Medical University of Vienna, Vienna, Austria
| | - Michel Yegles
- Laboratoire National de Santé, Service de Toxicologie médico-légale, Dudelange, Luxembourg
| | - Christian Datz
- Department of Internal Medicine 2 for Nephrology, Endocrinology, Rheumatology, and Gastroenterology, Johannes Kepler University Linz, Med Campus III, Linz, Austria
| | - Michael Trauner
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria
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5
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Mattia A, Moschella C, David MC, Fiore M, Gariglio S, Salomone A, Vincenti M. Development and Validation of a GC-EI-MS/MS Method for Ethyl Glucuronide Quantification in Human Hair. Front Chem 2022; 10:858205. [PMID: 35444998 PMCID: PMC9013907 DOI: 10.3389/fchem.2022.858205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite detectable in several matrices for specific periods of time. In recent years, quantification of EtG in hair has been established as the most reliable biomarker for long-term alcohol consumption, with the Society of Hair Testing offering cut-off values for assessment of both abstinence and heavy drinking. Instrumental constrains and wide inter- and intra-laboratory variability represent the ultimate barriers to widespread acceptance of hair EtG determination in the forensic context. In this study, a new analytical method for hair EtG based on gas chromatographic (GC) separation, electron impact (EI) ionization, and tandem mass spectrometry (MS/MS) detection was developed and validated. At the same time, several parameters for sample pretreatment and instrumental analysis were optimized using real hair samples obtained from different drinking subjects. A full-factorial design-of-experiment approach included procedures for hair washing, pulverization, and extraction. Rigorous multi-step washing proved not to reduce the EtG content extracted in the subsequent sample incubation. Hair pulverization with a ball mill significantly improved the EtG extraction from the keratin matrix and allowed us to reduce the time needed for the subsequent extraction step, without affecting the extraction recovery. The hair extract was derivatized with N-methyl-N-(trimethylsilyl)-trifluoroacetamide. Upon electron impact ionization of the EtG-TMS derivative, triple quadrupole mass analyzers were operated in the selected reaction monitoring (SRM) mode using the fragment m/z 405 as the precursor ion (m/z 410 for the EtG-D5 internal standard), the transitions m/z 405 → 359 and m/z 410 → 359 for quantitation, and m/z 405 → 331 and m/z 405 → 287 for qualification/confirmation, all at 10 V collision energy. The final method was fully validated and then applied to 25 real hair samples. The calibration curve proved linear between 6 and 60 pg/mg. The limit of detection (LOD) was 4 pg/mg. Intra- and inter-assay precision and accuracy tests showed a variability and bias close to 15% or lower over the entire calibration range. The new method is routinely applied in the Italian State Police’s toxicology laboratory for hair analyses addressed to exclude excessive alcohol drinking and verify the psycho-physical requirements of the personnel.
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Affiliation(s)
- Alessandro Mattia
- Dipartimento della Pubblica Sicurezza, Direzione Centrale di Sanità, Centro di Ricerche e Laboratorio di Tossicologia Forense, Ministero dell’Interno, Roma, Italy
| | - Clementina Moschella
- Dipartimento della Pubblica Sicurezza, Direzione Centrale di Sanità, Centro di Ricerche e Laboratorio di Tossicologia Forense, Ministero dell’Interno, Roma, Italy
| | - Maria Chiara David
- Dipartimento della Pubblica Sicurezza, Direzione Centrale di Sanità, Centro di Ricerche e Laboratorio di Tossicologia Forense, Ministero dell’Interno, Roma, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC—CNR, Rome, Italy
| | - Sara Gariglio
- Dipartimento di Chimica, Università Degli Studi di Torino, Torino, Italy
| | - Alberto Salomone
- Dipartimento di Chimica, Università Degli Studi di Torino, Torino, Italy
- *Correspondence: Alberto Salomone,
| | - Marco Vincenti
- Dipartimento di Chimica, Università Degli Studi di Torino, Torino, Italy
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Freni F, Moretti M, Scardo S, Carelli C, Vignali C, Monti MC, Morini L. Ethyl glucuronide in hair: a 5-years retrospective cohort study in subjects sanctioned for driving under the influence of alcohol and psychoactive substances. Drug Test Anal 2022; 14:1417-1428. [PMID: 35355418 PMCID: PMC9543301 DOI: 10.1002/dta.3265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The evaluation of drinking behaviours can help in limiting high-risk situation, such as driving under the influence (DUI). We investigate ethyl glucuronide in hair (hEtG) levels to evaluate alcohol consumption behaviour in subjects followed up after having been charged for DUI of psychoactive substances and/or alcohol. METHODS We performed a retrospective observational cohort study on 4328 subjects over 18 years old who underwent hEtG analysis in the period 2015-2019 in the Italian Province of Pavia. hEtG level was used as a proxy for the alcohol consumption behaviour. Effects of age, sex and district on alcohol drinking behaviour were investigated with an ordinal logit model. A state sequence analysis was used to study people's alcohol consumption behaviour over time. RESULTS hEtG was found ≥7.0 pg/mg in 22.2% of the drivers (of which 7% has an hEtG ≥30.0 pg/mg). Among positive cases, a prevalence of males (96.3%) aged 35-44 (32.6%), coming from main city and hinterland (38.2%) was observed. The propensity to drink was higher for males (OR≈2.28, p<0.001) and for subject coming from the district devoted to the cultivation of vineyards. Young age classes have a reduced drinking risk if compared to the drivers over 55 years old (p<0.001). A general decreasing trend over time in hEtG values was observed. CONCLUSION Being male, age ≥ 55 years, and coming from rural areas are potential risk factors related to alcohol drinking habits among drivers. Ethyl glucuronide in hair test in the driving license reissuing protocol contributed to decrease alcohol misuse behaviours.
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Affiliation(s)
- Francesca Freni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
| | - Matteo Moretti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
| | - Sara Scardo
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Claudia Carelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
| | - Claudia Vignali
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
| | - Luca Morini
- Department of Public Health, Experimental and Forensic Medicine, Unit of Legal Medicine, University of Pavia, Pavia, Italy
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7
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Vincenti F, Montesano C, Oliva E, Fanti F, Vincenti M, Salomone A, Compagnone D, Curini R, Sergi M. Accelerated Extraction and Analysis of Ethyl Glucuronide in Hair by Means of Pressurized Liquid Extraction Followed by Liquid Chromatography-Tandem Mass Spectrometry Determination. J Anal Toxicol 2021; 45:927-936. [PMID: 33002142 DOI: 10.1093/jat/bkaa141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/31/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
The measurement of ethyl glucuronide (EtG) in hair is an established practice to evaluate alcohol consumption habits of the donors; nevertheless, analytical variability has shown to be an important factor to be considered: measured EtG values can vary significantly as a consequence of analyte washout during decontamination, pulverization of samples, extraction solvent and incubation temperature. In the present study, we described a new method for automated hair decontamination and EtG extraction from the inner core of the hair by using pressurized liquid extraction (PLE), followed by solid-phase extraction (SPE) cleanup; validation was performed according to SWGTOX guidelines. The extraction efficiency of the new method was evaluated by comparing the results with those obtained by a validated and ISO/IEC 17025:2005 accredited method; an average positive difference of + 32% was observed when the extraction was performed by PLE. The effect of hair pulverization was also studied, and a good correlation between cut and milled hair was observed, implying that PLE allowed a highly efficient extraction of EtG from the inner keratin core of the hair, no matter if it has been cut or pulverized. Finally, to verify the results, paired aliquots of 27 real hair samples were analyzed with both PLE and a protocol optimized by design-of-experiment strategies planned to maximize the extraction yield; in this case, a comparable efficiency was observed, suggesting that exhaustive EtG extraction was obtained with both approaches. This finding opens new perspectives in the eligible protocols devoted to hair EtG analysis, in terms of speed, automation and reproducibility.
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Affiliation(s)
- Flaminia Vincenti
- Department of Chemistry, Sapienza University of Rome, 00185 Rome, Italy.,Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy
| | - Camilla Montesano
- Department of Chemistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Eleonora Oliva
- University of Teramo, Faculty of Bioscience and Technology for Food, Agriculture and Environment, 64100, Teramo, Italy
| | - Federico Fanti
- University of Teramo, Faculty of Bioscience and Technology for Food, Agriculture and Environment, 64100, Teramo, Italy
| | - Marco Vincenti
- Department of Chemistry, University of Turin, 10125 Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", 10043 Orbassano (Torino), Italy
| | - Alberto Salomone
- Department of Chemistry, University of Turin, 10125 Torino, Italy.,Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", 10043 Orbassano (Torino), Italy
| | - Dario Compagnone
- University of Teramo, Faculty of Bioscience and Technology for Food, Agriculture and Environment, 64100, Teramo, Italy
| | - Roberta Curini
- Department of Chemistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuel Sergi
- University of Teramo, Faculty of Bioscience and Technology for Food, Agriculture and Environment, 64100, Teramo, Italy
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Arnts J, Vanlerberghe BTK, Roozen S, Crunelle CL, Masclee AAM, Olde‐Damink SWM, Heeren RMA, van Nuijs A, Neels H, Nevens F, Verbeek J. Diagnostic Accuracy of Biomarkers of Alcohol Use in Patients With Liver Disease: A Systematic Review. Alcohol Clin Exp Res 2021; 45:25-37. [PMID: 33190239 PMCID: PMC7898850 DOI: 10.1111/acer.14512] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/09/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Alcohol-related liver disease is the most frequent cause of cirrhosis and a major indication for liver transplantation. Several alcohol use biomarkers have been developed in recent years and are already in use in several centers. However, in patients with liver disease their diagnostic performance might be influenced by altered biomarker formation by hepatic damage, altered excretion by kidney dysfunction and diuretics use, and altered deposition in hair and nails. We systematically reviewed studies on the diagnostic accuracy of biomarkers of alcohol use in patients with liver disease and performed a detailed study quality assessment. METHODS A structured search in PubMed/Medline/Embase databases was performed for relevant studies, published until April 28, 2019. The risk of bias and applicability concerns was assessed according to the adapted quality assessment of diagnostic accuracy studies-2 (QUADAS-2) checklist. RESULTS Twelve out of 6,449 studies met inclusion criteria. Urinary ethyl glucuronide and urinary ethyl sulfate showed high sensitivity (70 to 89 and 73 to 82%, respectively) and specificity (93 to 99 and 86 to 89%, respectively) for assessing any amount of alcohol use in the past days. Serum carbohydrate-deficient transferrin showed low sensitivity but higher specificity (40 to 79 and 57 to 99%, respectively) to detect excessive alcohol use in the past weeks. Whole blood phosphatidylethanol showed high sensitivity and specificity (73 to 100 and 90 to 96%, respectively) to detect any amount of alcohol use in the previous weeks. Scalp hair ethyl glucuronide showed high sensitivity (85 to 100%) and specificity (97 to 100%) for detecting chronic excessive alcohol use in the past 3 to 6 months. Main limitations of the current evidence are the lack of an absolute gold standard to assess alcohol use, heterogeneous study populations, and the paucity of studies. CONCLUSIONS Urinary and scalp hair ethyl glucuronide are currently the most validated alcohol use biomarkers in patients with liver disease with good diagnostic accuracies. Phosphatidylethanol is a highly promising alcohol use biomarker, but so far less validated in liver patients. Alcohol use biomarkers can complement each other regarding diagnostic time window. More validation studies on alcohol use biomarkers in patients with liver disease are needed.
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Affiliation(s)
- Janique Arnts
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Benedict T. K. Vanlerberghe
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Sylvia Roozen
- Governor Kremers Centre‐Maastricht University Medical Centre(SR)MaastrichtThe Netherlands
| | - Cleo L. Crunelle
- Department of Psychiatry(CLC)Vrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
- Toxicological Center(CLC, AN, HN)University of AntwerpAntwerpBelgium
| | - Ad A. M. Masclee
- From theDivision of Gastroenterology and Hepatology(JA, BTKV, AAMM)Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism(AAMM, SWMO‐D)Maastricht UniversityMaastrichtThe Netherlands
| | - Steven W. M. Olde‐Damink
- NUTRIM School of Nutrition and Translational Research in Metabolism(AAMM, SWMO‐D)Maastricht UniversityMaastrichtThe Netherlands
- Department of Surgery(Maastricht University Medical CenterMaastrichtThe Netherlands
- Department of General, Visceral and Transplantation Surgery(RWTH University Hospital AachenAachenGermany
| | - Ron M. A. Heeren
- Division of Imaging Mass Spectrometry(RMAH)Maastricht MultiModal Molecular Imaging (M4I) InstituteMaastricht UniversityMaastrichtThe Netherlands
| | | | - Hugo Neels
- Toxicological Center(CLC, AN, HN)University of AntwerpAntwerpBelgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology(FN, JV)University Hospitals KU LeuvenLeuvenBelgium
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology(FN, JV)University Hospitals KU LeuvenLeuvenBelgium
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Mosebach A, Aboutara N, Lago MR, Müller A, Lang M, Fischer L, Iwersen-Bergmann S, Sterneck M. Impaired diagnostic accuracy of hair ethyl glucuronide testing in patients with renal dysfunction. Forensic Sci Int 2020; 317:110518. [PMID: 33031981 DOI: 10.1016/j.forsciint.2020.110518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
The impact of renal impairment and hemodialysis on ethyl glucuronide concentrations in hair (hEtG) is not well known. Here, hEtG levels were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in patients presenting to the transplant outpatient clinic and compared with the self-reported alcohol consumption in an anonymous validated questionnaire. Estimated daily alcohol intake (EDI) was calculated. A total of 94 patients with varying renal function (Glomerular filtration rate (GFR) > 60 mL/min: group 1 (n = 47); GFR 30-60 ml/min: group 2 (n = 29); GFR < 30 mL/min: group 3 (n = 18)) were included in the study. Fifteen of 18 (83.3%) patients in group 3 were on dialysis. Altogether, hEtG tested positive (> 5 pg/mg) in 25.5% (n = 24) of patients, while 36.2% (n = 34) and 14.9% (n = 14) of patients reported any or regular (> 10 g/d) alcohol consumption, respectively. The median hEtG concentration of positive samples was much higher in patients in group 3 with advanced renal dysfunction or on dialysis than in patients in group 1 or 2 (group 1, 2, 3 dialysis patients: 74, 52, 145 and 155 pg/mg, respectively), although they consumed on average much less alcohol per day (median EDI group 1, 2, 3, dialysis patients: 16, 17, 3 and 3 g/d, respectively). Also, there was a significant correlation between the hEtG concentration and EDI for patients in group 1 (ρ = 0.84; p = 0.01), but not for patients in group 2 (ρ = -0.35, p = 0.39) or 3 (ρ = 0.02, p = 0.96). Furthermore, the ability of hEtG to correctly identify abstainers as such was lower for patients with advanced renal dysfunction than for the remaining patients (specificity for group 1, 2, 3: 92%, 87%, 82%, respectively). So, monitoring hEtG concentration was less reliable in patients with advanced renal dysfunction or on hemodialysis and by far overestimated the amount of alcohol consumed.
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Affiliation(s)
- Amadea Mosebach
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Aboutara
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Rodriguez Lago
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Müller
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melanie Lang
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martina Sterneck
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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10
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Kapur BM, Aleksa K. What the lab can and cannot do: clinical interpretation of drug testing results. Crit Rev Clin Lab Sci 2020; 57:548-585. [PMID: 32609540 DOI: 10.1080/10408363.2020.1774493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urine drug testing is one of the objective tools available to assess adherence. To monitor adherence, quantitative urinary results can assist in differentiating "new" drug use from "previous" (historical) drug use. "Spikes" in urinary concentration can assist in identifying patterns of drug use. Coupled chromatographic-mass spectrometric methods are capable of identifying very small amounts of analyte and can make clinical interpretation rather challenging, specifically for drugs that have a longer half-life. Polypharmacy is common in treatment and rehabilitation programs because of co-morbidities. Medications prescribed for comorbidities can cause drug-drug interaction and phenoconversion of genotypic extensive metabolizers into phenotypic poor metabolizers of the treatment drug. This can have significant impact on both pharmacokinetic (PK) and pharmacodynamic properties of the treatment drug. Therapeutic drug monitoring (TDM) coupled with PKs can assist in interpreting the effects of phenoconversion. TDM-PKs reflects the cumulative effects of pathophysiological changes in the patient as well as drug-drug interactions and should be considered for treatment medications/drugs used to manage pain and treat substance abuse. Since only a few enzyme immunoassays for TDM are available, this is a unique opportunity for clinical laboratory scientists to develop TDM-PK protocols that can have a significant impact on patient care and personalized medicine. Interpretation of drug screening results should be done with caution while considering pharmacological properties and the presence or absence of the parent drug and its metabolites. The objective of this manuscript is to review and address the variables that influence interpretation of different drugs analyzed from a rehabilitation and treatment programs perspective.
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Affiliation(s)
- Bhushan M Kapur
- Clini Tox Inc., Oakville, Canada.,Seroclinix Corporation, Mississauga, Canada
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11
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Biondi A, Freni F, Carelli C, Moretti M, Morini L. Ethyl glucuronide hair testing: A review. Forensic Sci Int 2019; 300:106-119. [PMID: 31096163 DOI: 10.1016/j.forsciint.2019.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/18/2022]
Abstract
Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite that can be detected in several matrices (e.g. blood, urine, hair, meconium) for variable periods of time. Quantification of EtG in hair (hEtG) has established itself, over recent years, as one of the most reliable biomarkers of long-term alcohol consumption habits, with the Society of Hair Testing (SoHT) offering cut-off values for assessment of both abstinence and heavy drinking (>60 g/day). Despite its high diagnostic performance, however, issues concerning inter- and intra-laboratory variability as well as data interpretation are still being investigated and represent the ultimate barrier to widespread acceptance of hEtG in the forensic context. The aim of this review is to summarize currently available analytical methods of hEtG testing, provide a framework to understand current hEtG cut-offs and their possible upcoming changes (in particular, a lower abstinence cut-off has been proposed for the 2019 revision of the SoHT consensus), and offer a schematic but exhaustive overview of the pitfalls in result reproducibility and interpretation that may limit applications of hEtG testing in the forensic context. Ultimately, the purpose of the authors is not to undermine the reliability of hEtG as an alcohol use marker, but rather to enhance it by promoting familiarization with all aspects related to it, from ethanol pharmacokinetics and EtG incorporation into hair, to sample preparation and analytical methods, to specific cases warranting close attention and additional tests for correct interpretation of hEtG results.
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Affiliation(s)
- Anna Biondi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesca Freni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Claudia Carelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Matteo Moretti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Luca Morini
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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12
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Małkowska A, Bamburowicz-Klimkowska M, Łukasik M, Grucza K, Szutowski M, Kwiatkowska D. The influence of caffeine on ethyl glucuronide levels in rat serum and in rat hair. Pharmacol Rep 2018; 70:831-836. [PMID: 32002974 DOI: 10.1016/j.pharep.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/09/2018] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ethanol and caffeine are the most widely used psychoactive substances in the world, with an observed steady increase in the combined consumption of alcohol and caffeine. Specific signs of ethanol-caffeine interactions have been reported both in humans and in animals. The metabolic effects of these interactions have not been fully elucidated. There are no published reports on the influence of caffeine on ethyl glucuronide (EtG) formation. EtG is a direct metabolite of ethanol and is very often used as a biomarker of alcohol consumption. Here, we investigated the influence of caffeine on the formation of EtG in rat plasma and EtG incorporation into the hair. METHODS Studies were conducted on three male Wistar rat groups, each receiving either ethanol at 3 g/kg/day, ethanol (at the same dose) with caffeine at 3 mg/kg/day, or caffeine at 3 mg/kg/day for four weeks. EtG and caffeine levels were evaluated in hair and in blood after the last administration. RESULTS Blood EtG levels after the administration of ethanol together with caffeine were significantly higher than after the administration of ethanol alone. EtG levels in rat hair in the ethanol-and-caffeine group were also higher than in the ethanol-only group, but the difference was not statistically significant. CONCLUSION This study shows the possible effect of ethanol and caffeine co-administration on EtG formation. Caffeine stimulates EtG synthesis resulting in increased blood and, possibly, hair levels of this metabolite. However, the role of these changes in estimating alcohol consumption requires further studies.
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Affiliation(s)
- Anna Małkowska
- Department of Applied Toxicology, Faculty of Pharmacy, Medical University of Warsaw, Warszawa, Poland.
| | | | - Marcin Łukasik
- Department of Applied Toxicology, Faculty of Pharmacy, Medical University of Warsaw, Warszawa, Poland
| | - Krzysztof Grucza
- Department of Applied Toxicology, Faculty of Pharmacy, Medical University of Warsaw, Warszawa, Poland.,Department of Anti-Doping Research, Institute of Sport - National Research Institute, Warszawa, Poland
| | - Mirosław Szutowski
- Department of Applied Toxicology, Faculty of Pharmacy, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Kwiatkowska
- Department of Anti-Doping Research, Institute of Sport - National Research Institute, Warszawa, Poland
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13
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EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69:154-181. [PMID: 29628280 DOI: 10.1016/j.jhep.2018.03.018] [Citation(s) in RCA: 495] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
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14
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Pragst F, Suesse S, Salomone A, Vincenti M, Cirimele V, Hazon J, Tsanaclis L, Kingston R, Sporkert F, Baumgartner MR. Commentary on current changes of the SoHT 2016 consensus on alcohol markers in hair and further background information. Forensic Sci Int 2017; 278:326-333. [DOI: 10.1016/j.forsciint.2017.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/20/2017] [Accepted: 07/20/2017] [Indexed: 11/26/2022]
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15
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Andresen-Streichert H, Beres Y, Weinmann W, Schröck A, Müller A, Skopp G, Pischke S, Vettorazzi E, Lohse A, Nashan B, Sterneck M. Improved detection of alcohol consumption using the novel marker phosphatidylethanol in the transplant setting: results of a prospective study. Transpl Int 2017; 30:611-620. [DOI: 10.1111/tri.12949] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/20/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yannick Beres
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Wolfgang Weinmann
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Alexandra Schröck
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Alexander Müller
- Department of Legal Medicine; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Gisela Skopp
- Department of Legal Medicine; University Medical Center Heidelberg; Heidelberg Germany
| | - Sven Pischke
- Department of Medicine (Med Klinik I); University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Ansgar Lohse
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg - Eppendorf; Hamburg Germany
| | - Martina Sterneck
- Department of Medicine (Med Klinik I); University Medical Center Hamburg - Eppendorf; Hamburg Germany
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16
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Crunelle CL, Neels H, Maudens K, De Doncker M, Cappelle D, Matthys F, Dom G, Fransen E, Michielsen P, De Keukeleire S, Covaci A, Yegles M. Influence of Body Mass Index on Hair Ethyl Glucuronide Concentrations. Alcohol Alcohol 2016; 52:19-23. [PMID: 27797711 DOI: 10.1093/alcalc/agw079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/05/2016] [Indexed: 11/14/2022] Open
Abstract
AIM Analysis of ethyl glucuronide (EtG) concentrations in hair is increasingly used to estimate the consumption of alcohol of the prior months. Linear correlations between the amount of alcohol consumed and the concentration of EtG in hair have been reported, and several variables that may influence this correlation have been investigated: e.g. cosmetic hair treatments, gender influences or hair color. Here, we investigate the influence of body mass index (BMI) on this correlation. METHODS A post hoc analysis on the influence of BMI on the relation between amounts of alcohol consumed and the measured EtG concentrations in hair in 199 participants. RESULTS Our data show higher EtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25) (P = 0.001) across a wide range of amounts of alcohol consumed. CONCLUSIONS We conclude that BMI should be taken into account when interpreting hair EtG concentrations. SHORT SUMMARY Ethyl glucuronide concentrations in hair (hEtG) can be used to estimate the consumption of alcohol of the prior months. Body mass index (BMI) influences this relation and BMI should be taken into account when interpreting hEtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25).
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Affiliation(s)
- Cleo L Crunelle
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium .,Department of Psychiatry, University Hospital Brussels (UZ Brussel), Jette, Belgium
| | - Hugo Neels
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium.,Toxicology and TDM Laboratory, ZNA Stuivenberg, Antwerp, Belgium
| | - Kristof Maudens
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium
| | | | - Delphine Cappelle
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Frieda Matthys
- Department of Psychiatry, University Hospital Brussels (UZ Brussel), Jette, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Belgium
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerpen, Belgium
| | - Steven De Keukeleire
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium.,Departement of Laboratory Medicine, AZ Alma, Eeklo, Belgium
| | - Adrian Covaci
- Department of Pharmaceutical Sciences, Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Michel Yegles
- Laboratoire National de Santé, Service de Toxicologie, Dudelange, Luxembourg
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