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Hoisington AJ, Choy K, Khair S, Dyamenahalli KU, Najarro KM, Wiktor AJ, Frank DN, Burnham EL, McMahan RH, Kovacs EJ. Recent alcohol intake impacts microbiota in adult burn patients. Alcohol 2024; 118:25-35. [PMID: 38604285 PMCID: PMC11179986 DOI: 10.1016/j.alcohol.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
Alcohol use is associated with an increased incidence of negative health outcomes in burn patients due to biological mechanisms that include a dysregulated inflammatory response and increased intestinal permeability. This study used phosphatidylethanol (PEth) in blood, a direct biomarker of recent alcohol use, to investigate associations between a recent history of alcohol use and the fecal microbiota, short chain fatty acids, and inflammatory markers in the first week after a burn injury for nineteen participants. Burn patients were grouped according to PEth levels of low or high and differences in the overall fecal microbial community were observed between these cohorts. Two genera that contributed to the differences and had higher relative abundance in the low PEth burn patient group were Akkermansia, a mucin degrading bacteria that improves intestinal barrier function, and Bacteroides, a potentially anti-inflammatory bacteria. There was no statistically significant difference between levels of short chain fatty acids or intestinal permeability across the two groups. To our knowledge, this study represents the first report to evaluate the effects of burn injury and recent alcohol use on early post burn microbiota dysbiosis, inflammatory response, and levels of short chain fatty acids. Future studies in this field are warranted to better understand the factors associated with negative health outcomes and develop interventional trials.
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Affiliation(s)
- Andrew J Hoisington
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA; Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson Air Force Base, OH, USA
| | - Kevin Choy
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shanawaj Khair
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kiran U Dyamenahalli
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kevin M Najarro
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA
| | - Arek J Wiktor
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel N Frank
- GI and Liver Innate Immune Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ellen L Burnham
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; Alcohol Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel H McMahan
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA
| | - Elizabeth J Kovacs
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Alcohol Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Sharma P, Shenoy A, Shroff H, Kwong A, Lim N, Pillai A, Devuni D, Haque LY, Balliet W, Serper M. Management of alcohol-associated liver disease and alcohol use disorder in liver transplant candidates and recipients: Challenges and opportunities. Liver Transpl 2024; 30:848-861. [PMID: 38471008 DOI: 10.1097/lvt.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Alcohol-associated liver disease poses a significant global health burden, with rising alcohol consumption and prevalence of alcohol use disorder (AUD) contributing to increased morbidity and mortality. This review examines the challenges and opportunities in the care of candidates and recipients of liver transplant (LT) with AUD. Despite advancements in posttransplant patient survival, the risk of disease recurrence and alcohol relapse remains substantial. Several challenges have been identified, including (1) rising disease burden of alcohol-associated liver disease, variable transplant practices, and systemic barriers; (2) disparities in mental health therapy access and the impact on transplant; (3) variable definitions, underdiagnosis, and stigma affecting access to care; and (4) post-LT relapse, its risk factors, and consequential harm. The review focuses on the opportunities to improve AUD care for candidates and recipients of LT through effective biochemical monitoring, behavioral and pharmacologic approaches, creating Centers of Excellence for post-LT AUD care, advocating for policy reforms, and ensuring insurance coverage for necessary services as essential steps toward improving patient outcomes. The review also highlights unmet needs, such as the scarcity of addiction specialists, and calls for further research on personalized behavioral treatments, digital health, and value-based care models to optimize AUD care in the LT setting.
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Affiliation(s)
- Pratima Sharma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Hersh Shroff
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison Kwong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Stanford University, Stanford, California, USA
| | - Nicholas Lim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Deepika Devuni
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Lamia Y Haque
- Department of Internal Medicine, Section of Digestive Diseases and Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Fitzpatrick-Schmidt T, Oral E, Welsh DA, Molina PE, Ferguson TF, Edwards S. Moderate-to-severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1405-1416. [PMID: 38825691 DOI: 10.1111/acer.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. METHODS Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. RESULTS The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. CONCLUSIONS Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.
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Affiliation(s)
- Taylor Fitzpatrick-Schmidt
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Biostatistics, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Epidemiology, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Scott Edwards
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
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Finanger T, Melby K, Spigset O, Andreassen TN, Lydersen S, Skråstad RB. Relationship between alcohol intake based on daily smartphone-reported consumption and PEth concentrations in healthy volunteers. Alcohol Alcohol 2024; 59:agae040. [PMID: 38881524 PMCID: PMC11180986 DOI: 10.1093/alcalc/agae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
AIMS To investigate the association between alcohol consumption registered daily with a digital smartphone-based diary and concentration of phosphatidylethanol (PEth) 16:0/18:1 in a population without a known alcohol use disorder (AUD), and evaluate whether prospective registration of alcohol consumption is better than retrospective registration and if the association between alcohol intake and PEth was affected by sex or body mass index (BMI). METHODS A total of 41 women and 21 men without AUD-diagnosis registered their alcohol consumption prospectively with a digital diary for 14 days, and retrospectively with the Timeline Followback method in the same time interval. PEth was measured before and after the registration period. RESULTS The correlation between alcohol consumption and PEth varied from 0.65 to 0.87. It did not depend significantly on the reporting method, and was not influenced by sex or BMI. Based on the regression coefficient, a reduction of alcohol consumption by two alcohol units (26 g of pure ethanol) per day would lead to a reduction of the PEth concentration of about 0.1 μmol/l, and vice versa. CONCLUSIONS There was a good correlation between PEth concentration and alcohol consumption, both when alcohol consumption was reported prospectively and retrospectively. The preferred cut-off for PEth should be adjusted to the level of alcohol consumption considered harmful and a purposeful trade-off between sensitivity and specificity. In order to identify persons with a daily alcohol consumption of more than two or three units of alcohol with a sensitivity of 80% or 90%, we suggest a cut-off of around 0.1 μmol/l.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Katrine Melby
- Clinic of Blue Cross Lade Addiction Treatment Centre, 7041 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Trine N Andreassen
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, 7030 Norway
| | - Ragnhild Bergene Skråstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
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Burnham EL, Pomponio R, Perry G, Offner PJ, Ormesher R, Peterson RA, Jolley SE. Prevalence of Alcohol Use Characterized by Phosphatidylethanol in Patients With Respiratory Failure Before and During the COVID-19 Pandemic. CHEST CRITICAL CARE 2024; 2:100045. [PMID: 38818345 PMCID: PMC11138642 DOI: 10.1016/j.chstcc.2023.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Alcohol misuse is overlooked frequently in hospitalized patients, but is common among patients with pneumonia and acute hypoxic respiratory failure. Investigations in hospitalized patients rely heavily on self-report surveys or chart abstraction, which lack sensitivity. Therefore, our understanding of the prevalence of alcohol misuse before and during the COVID-19 pandemic is limited. RESEARCH QUESTION In critically ill patients with respiratory failure, did the proportion of patients with alcohol misuse, defined by the direct biomarker phosphatidylethanol, vary over a period including the COVID-19 pandemic? STUDY DESIGN AND METHODS Patients with acute hypoxic respiratory failure receiving mechanical ventilation were enrolled prospectively from 2015 through 2019 (before the pandemic) and from 2020 through 2022 (during the pandemic). Alcohol use data, including Alcohol Use Disorders Identification Test (AUDIT)-C scores, were collected from electronic health records, and phosphatidylethanol presence was assessed at ICU admission. The relationship between clinical variables and phosphatidylethanol values was examined using multivariable ordinal regression. Dichotomized phosphatidylethanol values (≥ 25 ng/mL) defining alcohol misuse were compared with AUDIT-C scores signifying misuse before and during the pandemic, and correlations between log-transformed phosphatidylethanol levels and AUDIT-C scores were evaluated and compared by era. Multiple imputation by chained equations was used to handle missing phosphatidylethanol data. RESULTS Compared with patients enrolled before the pandemic (n = 144), patients in the pandemic cohort (n = 92) included a substantially higher proportion with phosphatidylethanol-defined alcohol misuse (38% vs 90%; P < .001). In adjusted models, absence of diabetes, positive results for COVID-19, and enrollment during the pandemic each were associated with higher phosphatidylethanol values. The correlation between health care worker-recorded AUDIT-C score and phosphatidylethanol level was significantly lower during the pandemic. INTERPRETATION The higher prevalence of phosphatidylethanol-defined alcohol misuse during the pandemic suggests that alcohol consumption increased during this period, identifying alcohol misuse as a potential risk factor for severe COVID-19-associated respiratory failure. Results also suggest that AUDIT-C score may be less useful in characterizing alcohol consumption during high clinical capacity.
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Affiliation(s)
- Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Raymond Pomponio
- Department of Medicine, Biostatistics and Informatics, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora CO
| | - Grace Perry
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Patrick J Offner
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Ryen Ormesher
- Colorado School of Public Health, and Internal Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora CO
| | - Ryan A Peterson
- Department of Medicine, Biostatistics and Informatics, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora CO
| | - Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Winder GS, Clifton EG, Denysenko L, DiChiara AM, Hathaway D, Perumalswami PV, Shenoy A, Suzuki J, Tareen K, Mellinger JL, Fernandez AC. "But I didn't drink!": What to do with discordant phosphatidylethanol results. Liver Transpl 2024; 30:213-222. [PMID: 37486958 DOI: 10.1097/lvt.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
Liver transplantation (LT) teams must be adept at detecting, evaluating, and treating patients' alcohol use, given its prominence among psychological and behavioral phenomena which cause and contribute to liver diseases. Phosphatidylethanol (PEth) is a highly useful alcohol biomarker increasingly recommended for routine use in hepatology and LT. PEth is unique among alcohol biomarkers because of its wide detection window, high sensitivity and specificity, and the correlation of its numerical value with different patterns of alcohol use. Alongside myriad clinical opportunities in hepatology and LT, PEth also confers numerous challenges: little guidance exists about its clinical use; fearing loss of LT access and the reactions of their clinicians and families, candidates and recipients are incentivized to conceal their alcohol use; and liver clinicians report lack of expertise diagnosing and treating substance-related challenges. Discordance between patient self-reported alcohol use and toxicology is yet another common and particularly difficult circumstance. This article discusses the general toxicological properties of PEth; explores possible scenarios of concordance and discordance among PEth results, patient history, and self-reported drinking; and provides detailed clinical communication strategies to explore discordance with liver patients, a key aspect of its use.
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Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lex Denysenko
- Department of Psychiatry, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alex M DiChiara
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - David Hathaway
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ponni V Perumalswami
- Department of Internal Medicine, Gastroenterology Section, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University, New York City, New York, USA
| | - Joji Suzuki
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kinza Tareen
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jessica L Mellinger
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Edelman EJ, Rojas-Perez OF, Nich C, Corvino J, Frankforter T, Gordon D, Jordan A, Paris M, Weimer MB, Yates BT, Williams EC, Kiluk BD. Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population. Addict Sci Clin Pract 2023; 18:55. [PMID: 37726823 PMCID: PMC10510167 DOI: 10.1186/s13722-023-00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. METHODS We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. CONCLUSIONS Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05338151.
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Affiliation(s)
- E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA.
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Social and Behavioral Sciences, Yale School of Medicine, New Haven, CT, USA.
| | | | - Charla Nich
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joanne Corvino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tami Frankforter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Derrick Gordon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- The Consultation Center, New Haven, CT, USA
| | - Ayana Jordan
- Department of Psychiatry, NYU Langone Health, New York, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Hispanic Clinic, Connecticut Mental Health Center, New Haven, CT, USA
| | - Melissa B Weimer
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Brian T Yates
- Department of Psychology, American University, Washington, DC, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research and Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration (VA), Seattle, WA, USA
| | - Brian D Kiluk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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8
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Perilli M, Toselli F, Franceschetto L, Cinquetti A, Ceretta A, Cecchetto G, Viel G. Phosphatidylethanol (PEth) in Blood as a Marker of Unhealthy Alcohol Use: A Systematic Review with Novel Molecular Insights. Int J Mol Sci 2023; 24:12175. [PMID: 37569551 PMCID: PMC10418704 DOI: 10.3390/ijms241512175] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Alcohol Use Disorders Identification Test (AUDIT) and its short form, the AUDIT-C, the main clinical instruments used to identify unhealthy drinking behaviors, are influenced by memory bias and under-reporting. In recent years, phosphatidylethanol (PEth) in blood has emerged as a marker of unhealthy alcohol use. This systematic review aims to investigate the molecular characteristics of PEth and summarize the last ten years of published literature and its use compared to structured questionnaires. A systematic search was performed, adhering to PRISMA guidelines, through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science. The inclusion criteria were as follows: PEth was used for detecting unhealthy alcohol consumption in the general population and quantified in blood through liquid chromatography coupled to mass spectrometry, with full texts in the English language. Quality assessment was performed using the JBI critical appraisal checklist. Twelve papers were included (0.79% of total retrieved records), comprising nine cross-sectional studies and three cohort studies. All studies stratified alcohol exposure and quantified PEth 16:0/18:1 through liquid chromatography coupled to mass spectrometry (LC-MS) in liquid blood or dried blood spots (DBS) with lower limits of quantitation (LLOQ) ranging from 1.7 ng/mL to 20 ng/mL. A correlation between blood PEth level and the amount of alcohol ingested in the previous two weeks was generally observed. PEth interpretative cut-offs varied greatly among the included records, ranging from 4.2 ng/mL to 250 ng/mL, with sensitivity and specificity in the ranges of 58-100% and 64-100%, respectively. Although the biomarker seems promising, further research elucidating the variability in PEth formation and degradation, as well as the molecular mechanisms behind that variability, are necessary.
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Affiliation(s)
| | | | | | | | | | | | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy; (M.P.); (F.T.); (L.F.); (A.C.); (A.C.); (G.C.)
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9
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Chen JS, Chander G, Tran HV, Sripaipan T, Hoa NTK, Miller WC, Latkin CA, Dowdy DW, Hutton HE, Frangakis C, Go VF. Phosphatidylethanol and self-reported alcohol consumption among people living with HIV in Thai Nguyen, Vietnam. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1100-1108. [PMID: 37069122 PMCID: PMC10289129 DOI: 10.1111/acer.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a biomarker for recent alcohol consumption that would ideally validate self-reported alcohol consumption behaviors. We assessed the relationship between PEth and several self-reported alcohol consumption metrics among hazardous alcohol users living with HIV in Vietnam. METHODS Participants in a three-arm randomized controlled trial assessing two alcohol interventions reported recent alcohol consumption on a 30-day timeline follow-back interview and had a PEth assessment at enrollment, 3 months, and 12 months of the study follow-up. We examined the relationship between self-reported alcohol consumption and quantitative PEth results using Spearman rank correlation and receiver-operating characteristic (ROC) curves to calculate the area under the curve (AUC). We assessed associations between categorical PEth results and self-reported drinking behaviors using prevalence ratios calculated with regression models and generalized estimating equations. RESULTS Among 1221 study visits (n = 439 participants; 425 (97%) men), the median PEth result was 71 ng/mL (Interquartile range (IQR): 20, 212), and participants reported a median of 11 (IQR: 4, 24) drinking days and 25 (IQR: 8, 71) standard drinks in the previous 28 days. Quantitative PEth results were moderately correlated with drinking days (ρ = 0.26-0.35) and standard drinks consumed (ρ = 0.23-0.38) in the same period. AUCs ranged from 0.54 (any binge drinking in the past 28 days) to 0.82 (any alcohol consumed in the past 21 days). Positive PEth results (≥50 ng/mL) were 2.24 (95% Confidence Interval [CI]: 1.49, 3.35) times as prevalent among participants who reported drinking in the previous 28 days compared with those who did not. CONCLUSIONS Although PEth values and self-reported alcohol use were correlated, the observed associations were modest. Additional research into the dynamics of PEth production and elimination is warranted across diverse populations to better understand how PEth assessments can best be integrated into research and clinical care.
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Affiliation(s)
- Jane S. Chen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Ha V. Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- University of North Carolina Vietnam, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ngo T. K. Hoa
- University of North Carolina Vietnam, Hanoi, Vietnam
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA
| | - Carl A. Latkin
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - David W. Dowdy
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Constantine Frangakis
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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10
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Choy K, Dyamenahalli KU, Khair S, Colborn KL, Wiktor AJ, Idrovo JP, McMahan RH, Burnham EL, Kovacs EJ. Aberrant inflammatory responses in intoxicated burn-injured patients parallel impaired cognitive function. Alcohol 2023; 109:35-41. [PMID: 36690221 PMCID: PMC10175175 DOI: 10.1016/j.alcohol.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
Burn-injured patients with alcohol use disorder (AUD) have increased morbidity and mortality compared to alcohol-abstaining individuals with similar injuries. It is hypothesized that this is due, in part, to alcohol-induced dysregulation of the systemic inflammatory response, leading to worsened clinical outcomes, including increased susceptibility to infection, and heightened cognitive impairment. To examine the effects of alcohol on inflammatory markers after burn injury, we used multiplex assays to measure a panel of 48 cytokines, chemokines, and growth factors in the plasma of burn patents within 24 h of admission to the University of Colorado Burn Center. Thirty patients were enrolled between July 2018 to February 2020 and were stratified based on presence of AUD and total body surface area (TBSA) burn of ≥20% into four groups: [AUD-, TBSA <20%, N = 12], [AUD+, TBSA <20%, N = 3], [AUD-, TBSA ≥20%, N = 8], [AUD+, TBSA ≥20%, N = 7]. In addition, Confusion Assessment Method (CAM) scores were collected to evaluate patient delirium during the course of hospitalization. Multivariate statistical analysis demonstrated a number of cytokines and other factors that were significantly different between the groups. For example, the anti-inflammatory cytokine interleukin 1 receptor antagonist (IL-1ra) was dampened in the AUD+, TBSA ≥20% cohort with a 75.2% decrease compared to AUD-, TBSA ≥20%, and an 83.9% decrease compared to AUD-, TBSA <20% (p = 0.008). Additionally, plasma levels of the pro-inflammatory mediator CXCL12 (C-X-C motif chemokine ligand 12, also known as stromal cell-derived factor 1, SDF-1) was higher in the AUD + groups (p = 0.03) and similarly, IL-18 levels were greater in AUD+, TBSA ≥20% (p = 0.009). Eotaxin (also known as cytokine CC motif ligand 11, CCL11) was markedly elevated in the AUD+, TBSA ≥20% cohort with a 2.4-fold increase over the AUD-, TBSA ≥20%, and a 1.7-fold rise compared to the AUD-, TBSA <20% cohorts (p = 0.04). Interestingly, there was also a marked rise in CAM + delirium scores (85.7%) among the AUD + patients with TBSA ≥20% (p = 0.02). Not surprisingly, we found that hospital stays increased with AUD+ and larger burns (p = 0.0009). Our findings reveal that burn patients who misuse alcohol have aberrant inflammatory responses that may lead to greater immune dysregulation and worse clinical outcomes.
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Affiliation(s)
- Kevin Choy
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kiran U Dyamenahalli
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Shanawaj Khair
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kathryn L Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Arek J Wiktor
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Juan-Pablo Idrovo
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel H McMahan
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Rocky Mountain Regional Veterans Administration Medical Center, Veterans Administration Eastern Colorado Health Care System Research Service, Aurora, CO, United States
| | - Ellen L Burnham
- Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth J Kovacs
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Rocky Mountain Regional Veterans Administration Medical Center, Veterans Administration Eastern Colorado Health Care System Research Service, Aurora, CO, United States; Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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11
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Herzog J, Skopp G, Musshoff F. Development and Validation of Seven Phosphatidylethanol Homologues in Dried Blood Spots Including Preliminary Results after Excessive Use of an Ethanol-Based Hand Sanitizer. J Anal Toxicol 2023; 47:245-252. [PMID: 36287059 PMCID: PMC9620346 DOI: 10.1093/jat/bkac086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Phosphatidylethanol (PEth) has become a widespread marker offering an up to 4-week retrospective window to detect alcohol use. Due to the pandemic of coronavirus disease 2019, ethanol-based hand sanitizers are frequently used. The aim of this study was to develop and validate a method for the determination of up to seven different homologues of PEth from dried blood spots (DBSs) after use of an ethanol-based hand sanitizer. The objectives of its preliminary application were to prove whether a threshold of 20 ng/mL for PEth 16:0/18:1 is reached and whether other homologues are formed as well as if positive findings of urinary ethyl glucuronide (UEtG) can be observed with respect to assess monitoring of abstinence control programs. Ten volunteers (8 occasional and 2 regular drinkers) were recruited to excessively use an ethanol-based hand sanitizer on 5 successive days. DBSs and urine samples were collected daily. PEth and UEtG were determined by liquid chromatography--tandem mass spectrometry. In total, two volunteers with initial PEth 16:0/18:1 concentrations of 19.3 and 14.6 ng/mL exceeded the threshold of 20 ng/mL six times. Subjects drinking daily or almost daily had starting PEth 16:0/18:1 concentrations of 242 and 354 ng/mL, showing a decline of PEth concentrations in six out of the seven homologues over 5 days. In teetotalers, formation of PEth species could not be observed. Thus, not satisfying requirements in an alcohol monitoring program with initial PEth-negative blood cannot be explained by a frequent use of ethanol-based hand sanitizer only. In cases of regular alcohol consumption, PEth homologues are not likely to be further influenced. However, results indicated that individuals with a PEth concentration close to 20 ng/mL are at risk of exceeding the threshold by using ethanol-based hand sanitizer.
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Affiliation(s)
- Josefine Herzog
- Corresponding author: Josefine Herzog Forensic Toxicological Center (FTC) Munich Dessauerstr. 13-15, 80992 Munich, Germanye-Mail:
| | - Gisela Skopp
- Forensic Toxicological Center Munich, Munich, Germany
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12
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Jolley SE, Mowry CJ, Erlandson KM, Wilson MP, Burnham EL. Impact of Alcohol Misuse on Requirements for Critical Care Services and Development of Hospital Delirium in Patients With COVID-19 pneumonia. Crit Care Explor 2023; 5:e0829. [PMID: 36713630 PMCID: PMC9876025 DOI: 10.1097/cce.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Alcohol misuse has been associated with increased morbidity in the setting of pulmonary infections, including the need for critical care resource utilization and development of delirium. How alcohol misuse impacts morbidity and outcomes among patients admitted with COVID-19 pneumonia is not well described. We sought to determine if alcohol misuse was associated with an increased need for critical care resources and development of delirium among patients hospitalized with COVID-19 pneumonia. DESIGN Retrospective cohort study. SETTING Twelve University of Colorado hospitals between March 2020 and April 2021. PATIENTS Adults with a COVID-19 diagnosis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was admission to the ICU. Secondary outcomes included need for mechanical ventilation, development of delirium, and in-hospital mortality. Alcohol misuse was defined by International Classification of Diseases, 10th Revision codes. Of 5,979 patients hospitalized with COVID-19, 26% required ICU admission and 15.4% required mechanical ventilation. Delirium developed in 4.5% and 10.5% died during hospitalization. Alcohol misuse was identified in 4%. In analyses adjusted for age, sex, body mass index, diabetes, and liver disease, alcohol misuse was associated with increased odds of ICU admission (adjusted odds ratio [aOR], 1.46; p < 0.01), mechanical ventilation (aOR, 1.43; p = 0.03), and delirium (aOR, 5.55; p < 0.01) compared with patients without misuse. Mortality rates were not associated with alcohol misuse alone, although the presence of both alcohol misuse and in-hospital delirium significantly increased odds of in-hospital death (aOR, 2.60; p = 0.04). CONCLUSIONS Among patients hospitalized with COVID-19, alcohol misuse was associated with increased utilization of critical care resources including ICU admission and mechanical ventilation. Delirium was an important modifiable risk factor associated with worse outcomes in hospitalized patients with alcohol misuse, including increased odds of death.
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Affiliation(s)
- Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Christopher J Mowry
- Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Kristine M Erlandson
- Division of Infectious Diseases, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Melissa P Wilson
- Department of Biostatistics, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Center, Aurora, CO
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13
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Verheij C, Haagsma JA, Koch BCP, Segers AEM, Schuit SCE, Rood PPM. Screening for hazardous alcohol use in the Emergency Department: Comparison of phosphatidylethanol with the Alcohol Use Disorders Identification Test and the Timeline Follow-back. Alcohol Clin Exp Res 2022; 46:2225-2235. [PMID: 36520053 PMCID: PMC10107187 DOI: 10.1111/acer.14958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/10/2022] [Accepted: 10/07/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Up to 15% of all visits to the Emergency Department (ED) are alcohol related. Identification of problematic alcohol use is important in this setting because it allows for intervention and prevention efforts. This study investigated the correlation between the objective phosphatidylethanol (PEth) marker and the subjective Alcohol Use Disorders Identification Test (AUDIT) and Timeline Followback Questionnaire (TLFB) as screening methods for hazardous alcohol use in the general ED population. METHODS This prospective cohort study included 301 ED patients (57% male) who were seen in the ED and required to give a blood sample. The correlation between the values of PEth (PEth 16:0/18:1 and PEth 16:0/18:2) and the scores on the AUDIT and TLFB were analyzed using Spearman's rank correlation coefficient. Differences between risk categories of PEth and AUDIT were also examined. RESULTS The Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and the AUDIT scores were moderate (PEth 16:0/18:1: 0.67, p < 0.001; PEth 16:0/18:2: 0.67, p < 0.001). Of the patients who scored 'low risk drinking/abstinence' according to the AUDIT questionnaire, respectively 1% and 4% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating excessive alcohol use, and another 10% and 12% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating moderate alcohol consumption. Of the 12 (PEth 16:0/18:1) and 25 (PEth 16:0/18:2) patients with high-risk values, respectively 25% and 40% scored in the lowest risk category on the AUDIT questionnaire. Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and TLFB two-week scores were high (PEth 16:0/18:1: 0.74, p < 0.001; PEth 16:0/18:2: 0.82, p < 0.001). CONCLUSIONS AUDIT scores were moderately correlated with PEth values in the general ED population. In almost all cases where there was not a good correlation, patients had high PEth values with low AUDIT scores. We conclude that PEth identifies patients with problematic alcohol use who are missed by the AUDIT questionnaire and therefore PEth could be used as an additional screening method for hazardous alcohol use in this population.
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Affiliation(s)
- Carolien Verheij
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne E M Segers
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stephanie C E Schuit
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Board of Directors, University Medical Center Groningen, Groningen, The Netherlands
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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Fernandez AC, Chapman L, Ren TY, Baxley C, Hallway AK, Tang MJ, Waljee JF, Friedmann PD, Mello M, Borsari B, Blow F. Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial. Surgery 2022; 172:1673-1681. [PMID: 36283843 PMCID: PMC10686250 DOI: 10.1016/j.surg.2022.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-risk alcohol use is a common surgical risk factor. Stopping or reducing alcohol use in the weeks before and after surgery could improve surgical health and outcomes. The purpose of this study was to evaluate the feasibility and acceptability of 2 interventions that address high-risk alcohol use in the context of surgery. METHODS Participants included patients scheduled for elective surgeries at an academic health system in the Midwestern United States. Recruitment took place by phone and text. Participants were included if they were 18 to 75 years old, scheduled for elective surgeries, and scored ≥5 on the Alcohol Use Disorders Identification Test-Consumption Tool. Participants were randomized to either a low-intensity intervention, brief advice (10-minute phone-based psychoeducation plus feedback session), or a higher-intensity intervention, health coaching (two 45-minute sessions including education, feedback, motivational interviewing, and goal setting). Assessments took place at baseline and at 1-month and 4-month follow-ups. Alcohol biomarkers were collected the day of surgery. RESULTS The final study sample included (n = 51) participants randomized to brief advice and health coaching conditions. Participants in both conditions rated interventions as satisfactory and personally relevant. Trial retention was high (86.3%) at 4 months. Attrition was significantly higher in brief advice (n = 6) relative to health coaching (n = 1). Average weekly alcohol use decreased 50% to 60% between baseline and follow-ups in both conditions. Biomarkers corroborated self-report. CONCLUSION The trial demonstrated intervention feasibility and acceptability. Alcohol use changed in expected directions. The next steps include a randomized controlled trial to test intervention efficacy in reducing alcohol use and surgical complications.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
| | - Lyndsay Chapman
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Tom Y Ren
- Central Michigan University College of Medicine, Mt. Pleasant, MI
| | - Catherine Baxley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | | | | | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Peter D Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School, Baystate, Springfield, MA
| | - Michael Mello
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Frederic Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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15
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Franceschetto L, Perilli M, Cinquetti A, Giraudo C, Gardi M, Cecchetto G, Viel G. Phosphatidylethanol in Maternal or Neonatal Blood to Detect Alcohol Exposure during Pregnancy: A Systematic Review. Life (Basel) 2022; 12:life12101528. [PMID: 36294962 PMCID: PMC9604963 DOI: 10.3390/life12101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy, even at low doses, may damage the fetus. Pregnant women tend to underreport their alcohol consumption generating the need for sensitive and specific biomarkers, among which PEth has emerged due to its high specificity and possibility to be measured in both maternal and neonatal blood. The aim of this study is to systematically review the latest 20 years of literature for depicting the state of the art, the limitations, and the prospects of PEth for estimating alcohol consumption during pregnancy. MATERIALS AND METHODS A systematic search, adhering to PRISMA guidelines, of the latest 20 years of literature through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science, with time limits 1 January 2002-1 March 2022, was performed. The inclusion criteria were as follows: PEth used for detecting alcohol consumption during pregnancy, quantified in blood through liquid chromatography coupled to mass spectrometry, and full texts in the English language. Opinion papers, editorials, and narrative reviews were excluded. RESULTS Sixteen (16) papers were included in the present review (0.81% of total retrieved records). All the included records were original articles, of which there were seven prospective cohort/longitudinal studies, six cross-sectional studies, two observational-descriptive studies, and one retrospective study. All studies assayed PEth in at least one biological matrix; seven (7) studies quantified PEth in maternal blood, seven studies in newborn blood, and only two studies in both maternal and neonatal blood. In several included papers, PEth proved more sensitive than self-reports for identifying pregnant women with an active alcohol intake with the diagnostic efficiency improving with the increase of the maternal alcohol intake. CONCLUSIONS Further studies, performed on wider and well-stratified populations, are needed to drive any definitive conclusion. PEth is a promising marker for monitoring alcohol use in pregnancy; however, at the present time, its use is still limited mainly by the absence of a globally agreed interpretative cut-off, the paucity of data regarding its specificity/sensitivity, and the lack of standardization on the diagnostic efficiency of the different isoforms.
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Affiliation(s)
- Lisa Franceschetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Matteo Perilli
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy
| | - Mario Gardi
- Unit of Urology, Sant’Antonio Hospital, University Hospital of Padua, 35100 Padua, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
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16
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McLaughlin MF, Jain JP, Ikeda J, Walker JE, Coffin P, Santos GM. Correlates of high phosphatidylethanol (PEth) levels and their concordance with self-reported heavy alcohol consumption among men who have sex with men who binge drink alcohol. Alcohol Clin Exp Res 2022; 46:1565-1579. [PMID: 35722862 PMCID: PMC10079307 DOI: 10.1111/acer.14891] [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: 01/27/2022] [Revised: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heavy alcohol use, including binge drinking, is associated with high morbidity and mortality among men who have sex with men (MSM). Self-reported alcohol measures may lead to inaccurate estimates due to recall and social desirability biases. Objective alcohol biomarkers like phosphatidylethanol (PEth) can be used to corroborate self-report and could help to inform treatment approaches and research strategies for alcohol using MSM. METHODS From 2015 to 2020, alcohol using MSM ≥18 years were enrolled in a randomized controlled trial evaluating the efficacy of naltrexone in reducing binge drinking. Using this trial's baseline data, we applied multivariable logistic regression to identify the correlates of high PEth levels (i.e., ≥87 ng/ml) and concordance between PEth levels and self-reported heavy drinking. RESULTS Of 118 MSM, 64% had PEth levels ≥87 ng/ml and 72% had PEth levels that were concordant with self-reported heavy alcohol use. Factors significantly associated in separate models with elevated PEth levels were income ≥$60,000 (adjusted odds ratio [aOR] = 4.09; 95% CI = 1.13 to 14.82), being employed (aOR = 4.04; 95% CI = 1.45 to 11.32), episodic cannabis use (aOR = 4.63; 95% CI = 1.27 to 16.92), and any alcohol/substance use prior to or during anal intercourse (aOR = 2.52; 95% CI = 1.08 to 5.90). Living with HIV was associated with significantly lower odds of elevated PEth levels (aOR = 0.23; 95% CI = 0.09 to 0.61). Factors associated with significantly higher concordance between PEth levels and self-reported heavy alcohol use included at least weekly use of poppers (aOR = 6.41; 95% CI = 1.27 to 32.28) and polysubstance use (aOR = 2.53; 95% CI = 1.02 to 6.27). Living with HIV was associated with lower odds of concordance (aOR = 0.36; 95% CI = 0.14 to 0.97). CONCLUSIONS PEth may enhance the detection of heavy drinking among MSM, including the identification of subpopulations that may benefit from targeted alcohol reduction interventions. However, PEth values for MSM living with HIV showed modest concordance with self-reported alcohol use and may need to be supplemented with additional biomarkers or evaluated against a different cutoff.
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Affiliation(s)
- Matthew F McLaughlin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - Jennifer P Jain
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Janet Ikeda
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - John E Walker
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - Phillip Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Glenn-Milo Santos
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
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17
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Shenoy A, Salajegheh A, Shen NT. Multimodal multidisciplinary management of alcohol use disorder in liver transplant candidates and recipients. Transl Gastroenterol Hepatol 2022; 7:28. [PMID: 35892051 PMCID: PMC9257538 DOI: 10.21037/tgh.2020.02.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/06/2019] [Indexed: 08/01/2023] Open
Abstract
Alcohol-related liver disease (ALD) is the most common indication for liver transplantation (LT) in the United States. The judicious allocation of organs and improvement in outcomes requires identification and monitoring of patients with ALD at high-risk for relapse post-transplantation. The controversial movement toward early LT for severe alcohol-related hepatitis (SAH) has also raised concern for alcohol relapse. While LT cures ALD, treatment of alcohol use disorder (AUD) must be included in the care plan to prevent a return to drinking and subsequent graft ALD. Patients with underlying AUD must be recognized, offered brief interventions and referred for multimodal multidisciplinary treatment that includes medications and psychotherapies along with sober support groups, family engagement, and a new dedication to healthy living in order to help sustain remission. Such comprehensive care will increase LT candidacy in patients with ALD while optimizing clinical outcomes of patients transplanted with AUD.
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Affiliation(s)
- Akhil Shenoy
- Director of Transplant Psychiatry, Assistant Professor, Columbia University Medical Center, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Columbia, New York, NY, USA
| | - Anna Salajegheh
- Assistant Professor, Weill Cornell Psychiatry, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Cornell, New York, NY, USA
| | - Nicole T. Shen
- Weill Cornell Medicine, Division of Clinical Epidemiology and Evaluative Sciences Research, Fellow, Transplant Hepatology, New York-Presbyterian Hospitals-Columbia and Cornell, New York, NY, USA
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18
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Van Uytfanghe K, Heughebaert L, Abatih E, Stove CP. Set-up of a population-based model to verify alcohol abstinence via monitoring of the direct alcohol marker phosphatidylethanol 16:0/18:1. Addiction 2022; 117:2108-2118. [PMID: 35072319 DOI: 10.1111/add.15811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Phosphatidylethanol 16:0/18:1 (PEth) is a biomarker for alcohol intake. It has a half-life of 7.9 days. Chronic alcohol consumption causes high PEth values. It can take weeks before PEth values fall below the decision limit for 'alcohol abstinence'. Our aim was to validate whether alcohol abstinence can be determined based on two consecutive PEth results above the decision limit. DESIGN Observational study. SETTING Belgium, February 2019. The study was linked to a social initiative in Belgium, 'Tournée Minérale'. PARTICIPANTS Adults (aged > 18 years, n = 796) with varying drinking habits who self-reportedly refrained from alcohol consumption during the study. MEASUREMENTS A validated liquid chromatography-tandem mass spectrometry method was used to quantify PEth in participants' dried blood samples, collected at three time-points via remote fingerprick-based self-sampling. FINDINGS A population-based algorithm to evaluate abstinence based on 95% prediction limits was developed by fitting a linear mixed-effect model to discern patterns in PEth elimination over time. It took intra- and inter-individual variability into consideration. The algorithm was included in a two-step decision tree, assessing whether (i) PEth values fell within the prediction interval and (ii) the slope between two PEth values was consistent with no alcohol consumption. Data for 74 participants reporting no alcohol intake during the study were used for validation. With a detection limit of 'four units spread over 14 days', the sensitivity and specificity of the decision tree was 89%. CONCLUSIONS Claims of alcohol abstinence can be verified using a two-step decision tree for phosphatidylethanol 16:0/18:1 values, even when those values are above the limit for 'alcohol abstinence'.
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Affiliation(s)
- Katleen Van Uytfanghe
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Liesl Heughebaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Emmanuel Abatih
- Fostering Innovative Research Based on Evidence (FIRE), Ghent University, Ghent, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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19
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Finanger T, Vaaler AE, Spigset O, Aamo TO, Andreassen TN, Gråwe RW, Skråstad RB. Identification of unhealthy alcohol use by self-report and phosphatidylethanol (PEth) blood concentrations in an acute psychiatric department. BMC Psychiatry 2022; 22:286. [PMID: 35449039 PMCID: PMC9026645 DOI: 10.1186/s12888-022-03934-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of standard screening methods could improve the detection rate of unhealthy alcohol use in patients admitted to psychiatric acute and emergency departments. The aim of the present study was to investigate the ability of the alcohol biomarker phosphatidylethanol (PEth) to identify patients with high levels of alcohol consumption prior to admission. METHODS The data were prospectively collected at admittance to an acute psychiatric department in the period January 2016 to June 2017. A blood sample for the analysis of PEth was available from 177 patients. We compared the PEth concentrations with the Alcohol Use Disorders Identification Test (AUDIT) scores during the hospital stay, and psychiatric diagnoses at discharge. RESULTS A total of 45.8% of the patients had a PEth concentration ≥ 0.03 μmol/L, indicating significant alcohol consumption. AUDIT scores consistent with unhealthy alcohol use were present in 51.7%. There was a significant positive correlation between PEth concentrations and AUDIT scores (r = 0.631, p < 0.001). PEth was above the detection limit of 0.03 μmol/L in 19% of those reporting an average daily intake of zero alcohol units per day during the last week before admission. PEth concentrations were significantly higher among those with an alcohol diagnosis than among those without such a diagnosis (0.82 μmol/L vs. 0.09 μmol/L, p = 0.001). CONCLUSION PEth provides supplementary information on recent alcohol consumption in a psychiatric population and would be particularly helpful in patients unable or unwilling to give such information at admission.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Klostergata 48, 7030, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Arne Einar Vaaler
- grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Olav Spigset
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trond Oskar Aamo
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trine Naalsund Andreassen
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf Wilhelm Gråwe
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Research and Development, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway
| | - Ragnhild Bergene Skråstad
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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20
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White D, O'Halloran S, Salman S, MacQuillan G, Joyce DA. Validation of a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for erythrocyte phosphatidylethanol revealing critical considerations for its use as a clinical biomarker. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1192:123134. [DOI: 10.1016/j.jchromb.2022.123134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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21
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Myoga Y, Manabe H, Osaki Y. The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study. BMC Anesthesiol 2021; 21:245. [PMID: 34645400 PMCID: PMC8513285 DOI: 10.1186/s12871-021-01456-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications. Methods We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications. Results Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48–71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications. Conclusions Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.
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Affiliation(s)
- Yoshinori Myoga
- Department of Anesthesiology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan. .,Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.
| | - Haruhiko Manabe
- Department of Anesthesiology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan
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22
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Steel TL, Afshar M, Edwards S, Jolley SE, Timko C, Clark BJ, Douglas IS, Dzierba AL, Gershengorn HB, Gilpin NW, Godwin DW, Hough CL, Maldonado JR, Mehta AB, Nelson LS, Patel MB, Rastegar DA, Stollings JL, Tabakoff B, Tate JA, Wong A, Burnham EL. Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e61-e87. [PMID: 34609257 PMCID: PMC8528516 DOI: 10.1164/rccm.202108-1845st] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T0-T4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T0-T1 (basic science research with translation to humans), T2 (research translating to patients), T3 (research translating to clinical practice), and T4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1) the need to investigate non-γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.
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23
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Justice AC. Alcohol and the global burden of cancer: what are we missing? Lancet Oncol 2021; 22:1048-1049. [PMID: 34270925 DOI: 10.1016/s1470-2045(21)00329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Amy C Justice
- Veterans Affairs Connecticut Healthcare System, Departments of Medicine and Health Policy and Management, Yale University, West Haven, CT 06516, USA.
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24
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Jørgenrud B, Kabashi S, Nadezhdin A, Bryun E, Koshkina E, Tetenova E, Lerdal A, Norby G, Kolgashkin A, Petukhov A, Perekhodov S, Davydova E, Vindenes V, Gamboa D, Bogstrand ST. The Association between the Alcohol Biomarker Phosphatidylethanol (PEth) and Self-Reported Alcohol Consumption among Russian and Norwegian Medical Patients. Alcohol Alcohol 2021; 56:726-736. [PMID: 33677484 PMCID: PMC8557652 DOI: 10.1093/alcalc/agab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol 16:0/18:1 (PEth) is a direct alcohol biomarker measuring alcohol consumption levels. The aim of this study was to investigate how PEth levels correlate with AUDIT-QF and weekly grams of alcohol consumed among patients in two urban hospitals. In addition, we wanted to investigate the predictive value of PEth in identifying harmful alcohol use as defined by AUDIT-QF and weekly grams of alcohol cutoffs. Methods A cross-sectional study comprising acute medically ill patients with measurable PEth levels (≥0.030 μM) admitted to two urban hospitals in Oslo, Norway (N = 931) and Moscow, Russia (N = 953) was conducted using PEth concentrations in whole blood, sociodemographic data and AUDIT-QF questionnaires. Results PEth levels from patients with measurable PEth were found to be positively correlated with AUDIT-QF scores, with PEth cutpoints of 0.128 μM (Oslo) and 0.270 μM (Moscow) providing optimal discrimination for harmful alcohol use defined by AUDIT-QF (the difference between cities probably reflecting different national drinking patterns in QF). When converting AUDIT-QF into weekly grams of alcohol consumed, the predictive value of PEth improved, with optimal PEth cutpoints of 0.327 (Oslo) and 0.396 (Moscow) μM discriminating between harmful and non-harmful alcohol use as defined in grams (≥350 grams/week). Conclusions By using PEth levels and converting AUDIT-QF into weekly grams of alcohol it was possible to get an improved rapid and sensitive determination of harmful alcohol use among hospitalized patients.
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Affiliation(s)
- Benedicte Jørgenrud
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Saranda Kabashi
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway
| | - Aleksei Nadezhdin
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, 125993, Barrikadnaya ul. 2/1, str. 1, Moscow, Russia
| | - Evgeny Bryun
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, 125993, Barrikadnaya ul. 2/1, str. 1, Moscow, Russia
| | - Evgenya Koshkina
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia
| | - Elena Tetenova
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia
| | - Anners Lerdal
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway.,Research Department, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen N-0440 Oslo, Norway
| | - Gudmund Norby
- Medical Department, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen N-0440 Oslo, Norway
| | - Alexey Kolgashkin
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia
| | - Alexei Petukhov
- Moscow Research and Practical Centre on Addictions of Moscow, Department of Public Health, 109390, Ljublinskaya ul. 37/1, Moscow, Russia.,Sechenov First Moscow State Medical University, 119991, Bolshaya Pirogovskaya ul. 2, str. 4, Moscow, Russia
| | - Sergey Perekhodov
- Demikhov Moscow Clinical Hospital, 109263, Shkuljova ul. 4, str. 1, Moscow, Russia
| | - Elena Davydova
- Demikhov Moscow Clinical Hospital, 109263, Shkuljova ul. 4, str. 1, Moscow, Russia
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway
| | - Danil Gamboa
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway.,Medical Department, Lovisenberg Diaconal Hospital, P.O. Box 04970, Nydalen N-0440 Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway
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25
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Quantitative determination of phosphatidylethanol in dried blood spots for monitoring alcohol abstinence. Nat Protoc 2020; 16:283-308. [PMID: 33288956 DOI: 10.1038/s41596-020-00416-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
Phosphatidylethanol (PEth), which is formed by enzymatic reaction between ethanol and phosphatidylcholine, is a direct marker for alcohol usage. PEth has a long elimination half-life (~5-10 d) and specimens can be sampled using minimally invasive microsampling strategies. In combination with rapid analysis procedures PEth has proved to be advantageous for the detection of abstinence over other direct (e.g., ethyl glucuronide in blood, urine or hair) and indirect (e.g., carbohydrate-deficient transferrin in serum) alcohol markers. Although PEth determination is widely applied around the world, laboratory protocols are not standardized. Here we provide general guidelines for the analysis of PEth in dried blood spots (DBSs), including reference material evaluation, synthesis of a deuterated internal standard, preparation of calibration samples (reference material in teetotaller blood), and analyte separation and detection. The protocol contains information to extract the DBSs either manually or with a fully automated autosampler. Extraction of the analytes from DBS filter paper cards is performed using an organic extraction, followed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). For accurate and reliable measurement of PEth, the two most abundant analogs, PEth 16:0/18:1 and PEth 16:0/18:2, are quantified. We show data that provide guidelines on how to interpret the results for both demographic studies and forensic applications. The described protocol can be applied by experienced laboratory staff with basic LC-MS/MS knowledge and takes 2 d to perform.
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26
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Cherrier MM, Shireman LM, Wicklander K, Yeung W, Kooner P, Saxon AJ, Simpson T, Terman G, Shen D. Relationship of Phosphatidylethanol Biomarker to Self-Reported Alcohol Drinking Patterns in Older and Middle-Age Adults. Alcohol Clin Exp Res 2020; 44:2449-2456. [PMID: 33038267 PMCID: PMC8476046 DOI: 10.1111/acer.14475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risky alcohol consumption is on the rise among older adults. Biomarkers such as phosphatidylethanol (PEth) have been used to evaluate the correspondence between an objective, laboratory-based biomarker and self-report of alcohol consumption. This study examined the relationship between PEth, self-report of alcohol consumption, and health indices in a sample of community-dwelling older to middle-age adults (aged 35 to 89) with healthy and risky levels of alcohol consumption. METHODS Self-reports of alcohol consumption were collected using the Alcohol Use Disorders Identification Test (AUDIT) and Form 30. In addition, indices of health along with a blood sample to determine PEth values were collected (N = 183). RESULTS PEth was correlated with age, AUDIT-C, AUDIT total, alcohol consumption, mood, and liver function measures but not with medical comorbidity or body mass index (J Gerontol B Psychol Sci Soc Sci 73, 2018, 633). Alcohol consumption over the past 30 days measured with Form 30 was the strongest predictor of PEth levels for both middle-age and older adults, with age a small contributing predictor. General alcohol consumption patterns for amount of alcohol consumed over a 30-day period revealed middle-age adults consumed larger amounts of alcohol compared with older adults, but older adults consumed alcohol on more days than middle-age adults. Middle-age participants evidenced higher PEth levels than older adults at comparable drinking rates. CONCLUSIONS Overall, findings suggest a strong relationship between alcohol consumption and PEth levels with age a small but contributing factor to predicting PEth levels.
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Affiliation(s)
- Monique M Cherrier
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Laura M Shireman
- Department of Pharmaceutics, (LMS, DS), School of Pharmacy, University of Washington, Seattle, Washington
| | - Katie Wicklander
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Winnie Yeung
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Preetma Kooner
- Department of Anesthesiology and Pain Medicine, (PK, GT), School of Medicine, University of Washington, Seattle, Washington
| | - Andrew J Saxon
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System, (AJS, TS), Seattle, Washington
| | - Tracy Simpson
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System, (AJS, TS), Seattle, Washington
| | - Greg Terman
- Department of Anesthesiology and Pain Medicine, (PK, GT), School of Medicine, University of Washington, Seattle, Washington
| | - Danny Shen
- Department of Pharmaceutics, (LMS, DS), School of Pharmacy, University of Washington, Seattle, Washington
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27
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Årving A, Høiseth G, Hilberg T, Trydal T, Husa A, Djordjevic A, Kabashi S, Vindenes V, Bogstrand ST. Comparison of the Diagnostic Value of Phosphatidylethanol and Carbohydrate‐Deficient Transferrin as Biomarkers of Alcohol Consumption. Alcohol Clin Exp Res 2020; 45:153-162. [DOI: 10.1111/acer.14503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Alexander Årving
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
| | - Gudrun Høiseth
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Thor Hilberg
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | - Torleif Trydal
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | - Asgeir Husa
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | | | - Saranda Kabashi
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Vigdis Vindenes
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Stig Tore Bogstrand
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
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28
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Ferguson TF, Rosen E, Carr R, Brashear M, Simon L, Theall KP, Ronis MJ, Welsh DA, Molina PE. Associations of Liver Disease with Alcohol Use among People Living with HIV and the Role of Hepatitis C: The New Orleans Alcohol Use in HIV Study. Alcohol Alcohol 2020; 55:28-36. [PMID: 31812989 DOI: 10.1093/alcalc/agz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
AIM This cross-sectional analysis of the New Orleans Alcohol Use in HIV (NOAH) study assesses whether current and lifetime alcohol use in people living with HIV (PLWH) are associated with greater liver disease and how hepatitis C-viral (HCV) co-infection (HIV/HCV+) modifies the association. METHODS Alcohol use was measured by Lifetime Drinking History (LDH), a 30-day Timeline Followback calendar, the Alcohol Use Disorder Identification Test, and phosphatidylethanol. Liver disease was estimated by alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST platelet ratio-index (APRI), fibrosis-4 index (FIB-4) and nonalcoholic fatty liver disease-fibrosis score. Associations between alcohol consumption and liver disease were estimated with multivariable logistic regression. Models were adjusted for age, sex, body-mass index, hepatitis B and HIV viral load. RESULTS Participants (N = 353) were majority male (69%) and black (84%) with a mean age of 48.3 ± 10 years. LDH was significantly associated with advanced liver fibrosis (FIB-4 aOR = 22.22 [1.22-403.72]) only among HIV/HCV+ participants with an LDH of 100-600 kg. HIV/HCV+ participants had a higher prevalence of intermediate and advanced liver disease markers than HIV/HCV- (P < 0.0001). Advanced markers of liver disease were most strongly associated with hazardous drinking (≥40(women)/60(men) grams/day) (APRI aOR = 15.87 (3.22-78.12); FIB-4 aOR = 6.76 (1.81-7.16)) and PEth ≥400 ng/ml (APRI aOR = 17.52 (2.55-120.54); FIB-4 aOR = 17.75 (3.30-95.630). CONCLUSION Results indicate a greater association of current alcohol use with liver disease than lifetime alcohol use, which varied by HCV status. These findings stress the importance of reducing alcohol use in PLWH to decrease risk of liver disease and fibrosis.
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Affiliation(s)
- Tekeda F Ferguson
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Erika Rosen
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Rotonya Carr
- University of Pennsylvania, Perelman School of Medicine, Division of Gastroenterology, 421 Curie Boulevard, 907 Biomedical Research Building II/III, Philadelphia, Pennsylvania 19104, PA, USA
| | - Meghan Brashear
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Liz Simon
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Katherine P Theall
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Martin J Ronis
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pharmacology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA, and
| | - David A Welsh
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pulmonology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Patricia E Molina
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
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Gerbase FE, Tegner M, Krutzmann ME, Muller VV, Alff JDA, da Silva VB, Sagrilo OP, Linden R, Antunes MV. Blood phosphatidyl ethanol levels as a tool to detect alcohol misuse in trauma patients. Clin Toxicol (Phila) 2020; 59:418-425. [PMID: 33021410 DOI: 10.1080/15563650.2020.1822531] [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] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There is a strong need for a reliable marker of harmful alcohol consumption to identify injured patients that can benefit from alcohol interventions, and blood phosphatidyl ethanol (PEth) has not previously been tested on this population. This study aims to compare the performance of blood PEth concentration, blood alcohol concentration (BAC) and the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) for the screening of alcohol misuse in trauma patients. METHODS Prospective cross-sectional study of 238 adult patients presenting in the emergency department with any type of trauma. PEth concentration was determined in whole blood by high-performance liquid chromatography with tandem mass spectrometry. Consent, AUDIT-C score and demographic data were obtained. RESULTS The sample consisted of majority male (67.6%), single (46.2%) and employed (66%) patients. The most common type of trauma was traffic collision (63.9%). The mean age was 41.7 years. We found a significant correlation between PEth levels with AUDIT-C score (Spearman's r = 0.654; p < .0001). PEth had an area under the ROC curve of 0.885 to detect hazardous alcohol consumption (AUDIT-C score ≥ 6) and PEth ≥23.9 ng/mL cutoff point provided 91.2% of sensitivity and 78.4% of specificity. Twelve patients reported alcohol abstinence, but had quantifiable levels of PEth. CONCLUSIONS PEth levels and AUDIT-C score had a moderate correlation in our population. PEth was useful to identify 12 cases of underreporting of alcohol consumption habits. PEth shows promising results, but more research is needed to identify the best screening tool for alcohol misuse in trauma patients.
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Affiliation(s)
- Fernando Engel Gerbase
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil.,Emergency Department, Novo Hamburgo Municipal Hospital, Novo Hamburgo, Brazil
| | - Mariane Tegner
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Maria Eduarda Krutzmann
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Victória Vendramini Muller
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Jonatan de Andrade Alff
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Vanessa Becher da Silva
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | | | - Rafael Linden
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Marina Venzon Antunes
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
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30
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Reisfield GM, Teitelbaum SA, Opie SO, Jones J, Morrison DG, Lewis B. The roles of phosphatidylethanol, ethyl glucuronide, and ethyl sulfate in identifying alcohol consumption among participants in professionals health programs. Drug Test Anal 2020; 12:1102-1108. [PMID: 32309913 DOI: 10.1002/dta.2809] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/11/2022]
Abstract
Direct alcohol biomarkers, including urinary ethyl glucuronide (EtG), urinary ethyl sulfate (EtS), and blood phosphatidylethanol (PEth), are used to monitor alcohol abstinence in individuals who are mandated to abstain. In this consecutive case series study, we examined 1000 forensic reports of participants enrolled in a professionals health program who were contractually obligated to abstain from alcohol and who underwent recovery status evaluations. We identified 52 evaluations in which urinary EtG, EtS, and blood PEth were measured and which produced a positive result for at least one of these analytes. PEth, at a cutoff concentration of 20 ng/mL, revealed alcohol use more frequently than EtG or EtS at our laboratory's cutoff concentrations of 100 and 25 ng/mL, respectively. This was true, as well, at alternative EtG/EtS cutoff concentrations of 200/50, 300/75, and 400/100 ng/mL. PEth was more likely than EtG/EtS to be positive in participants previously diagnosed with alcohol use disorders (AUD), whereas EtG/EtS was more likely than PEth to be positive in participants without AUD. In this study, blood PEth was the most sensitive biomarker for evidencing alcohol use.
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Affiliation(s)
- Gary M Reisfield
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Scott A Teitelbaum
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Shannon O Opie
- Florida Intervention Project for Nurses, Jacksonville Beach, Florida, FL 32240, USA
| | - Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, Illinois, USA
| | - Deborah G Morrison
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Ben Lewis
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
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31
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Ferguson TF, Theall KP, Brashear M, Maffei V, Beauchamp A, Siggins RW, Simon L, Mercante D, Nelson S, Welsh DA, Molina PE. Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study. Alcohol Clin Exp Res 2020; 44:1261-1272. [PMID: 32441814 DOI: 10.1111/acer.14336] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood. METHODS We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics. RESULTS Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort. CONCLUSIONS Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.
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Affiliation(s)
- Tekeda F Ferguson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katherine P Theall
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Meghan Brashear
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vincent Maffei
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans,, Louisiana
| | - Alaina Beauchamp
- Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert W Siggins
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Liz Simon
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Donald Mercante
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steve Nelson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David A Welsh
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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32
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Injury Characteristics and von Willebrand Factor for the Prediction of Acute Respiratory Distress Syndrome in Patients With Burn Injury: Development and Internal Validation. Ann Surg 2020; 270:1186-1193. [PMID: 29697443 DOI: 10.1097/sla.0000000000002795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To derive and validate a prediction model for the development of ARDS in burn-injured patients. SUMMARY BACKGROUND DATA Burn injury carries the highest incidence of acute respiratory distress syndrome (ARDS) among all predisposing conditions, but few studies exist on risk factors in these patients. Studies employing biomarkers and clinical risk factors for predicting ARDS mortality have recently been examined but none exist for onset of ARDS nor in patients with burn injury. METHODS This was a prospective multicenter study of 113 patients with isolated burn injury or inhalation injury. Clinical variables and plasma biomarkers representative of endothelial injury, epithelial injury, or inflammation were collected within 24 hours of admission. The most parsimonious model was chosen by considering discrimination, calibration, and model fit. RESULTS Among the biomarkers measured in patients with burn injuries, a one-standard deviation increase in log-transformed levels of the A2 domain of von Willebrand factor in the first 24 hours was most strongly associated with the development of ARDS (OR 7.72; 95% CI: 1.64-36.28, P = 0.03). Of candidate models, a 3-variable model with %TBSA, inhalation injury, and von Willebrand factor-A2 had comparable discrimination to more complex models (area under the curve: 0.90; 95% CI 0.85-0.96). The 3-variable model had good model fit by Hosmer-Lemeshow test (P = 0.74) and maintained similar discrimination after accounting for performance optimism (Bootstrapped area under the curve: 0.90; 95% CI: 0.84-0.95). CONCLUSIONS The 3-variable model with %TBSA, inhalation injury, and von Willebrand factor could be used to better identify at-risk patients for both the study and prevention of ARDS in patients with burn injury.
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Uljas E, Jalkanen V, Kuitunen A, Hynninen M, Hästbacka J. Prevalence of risk-drinking in critically ill patients, screened with carbohydrate-deficient transferrin and AUDIT-C score: A retrospective study. Acta Anaesthesiol Scand 2020; 64:216-223. [PMID: 31541613 DOI: 10.1111/aas.13484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. Methods We conducted a retrospective analysis of clinical and laboratory data from a single ICU where %CDT and AUDIT-C were included in routine assessment. After excluding readmissions, 2532 adult patients from a 21-month period were included. Admission values of %CDT were available for 2049 patients, and AUDIT-C was available for 1617 patients. The association of %CDT and AUDIT-C with short- and long-term outcome was studied by using univariate and multivariate logistic regression analysis. Results %CDT was above the reference value in 23.7% (486/2048) of patients with available %CDT. Of patients with available AUDIT-C, 33% (544/1617) had a risk-level AUDIT-C score. Patients with a risk-level AUDIT-C score were significantly younger than those with a lower score (51 vs 64 years, P < .0001). Increased %CDT was associated with higher severity of illness. AUDIT-C was associated independently with increased risk of long-term mortality in multivariate analysis (P = .007). Conclusion One in three of ICU patients are risk-level alcohol users as measured with AUDIT-C score, and one in four are analysed with %CDT. The prevalence varies according to the method used and any method alone may be insufficient to detect risk-level consumption reliably. Editorial Comment Alcohol overconsumption is associated with need for ICU admission and with less favorable outcomes. Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
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Affiliation(s)
- Eliisa Uljas
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Ville Jalkanen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Anne Kuitunen
- Department of Intensive Care University of Tampere Tampere University Hospital Tampere Finland
| | - Marja Hynninen
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Johanna Hästbacka
- Division of Intensive Care Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
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Gordon KS, McGinnis K, Dao C, Rentsch CT, Small A, Smith RV, Kember RL, Gelernter J, Kranzler HR, Bryant KJ, Tate JP, Justice AC. Differentiating Types of Self-Reported Alcohol Abstinence. AIDS Behav 2020; 24:655-665. [PMID: 31435887 DOI: 10.1007/s10461-019-02638-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We contrast three types of abstinence: quit after alcohol associated problems (Q-AP), quit for other reasons (Q-OR), and lifetime abstainer (LTA). We summarized the characteristics of people living with HIV (PLWH), and matched uninfected individuals, by levels of alcohol use and types of abstinence. We then identified factors that differentiate abstinence and determined whether the association with an alcohol biomarker or a genetic polymorphism is improved by differentiating abstinence. Among abstainers, 34% of PLWH and 38% of uninfected were Q-AP; 53% and 53% were Q-OR; and 12% and 10% were LTA. Logistic regression models found smoking, alcohol, cocaine, and hepatitis C increased odds of Q-AP, whereas smoking and marijuana decreased odds of LTA. Differentiating types of abstinence improved association. Q-APs and LTAs can be readily differentiated by an alcohol biomarker and genetic polymorphism. Differentiating type of abstinence may enhance understanding of alcohol health effects.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Kathleen McGinnis
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Cecilia Dao
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Christopher T Rentsch
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Aeron Small
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | | | - Rachel L Kember
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center VISN4 MIRECC, Philadelphia, PA, 19104, USA
| | - Joel Gelernter
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Henry R Kranzler
- Corporal Michael J. Crescenz Veterans Affairs Medical Center VISN4 MIRECC, Philadelphia, PA, 19104, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Janet P Tate
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
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Coker MS, Ladd KR, Kim J, Murphy CJ, DeCort R, Newcomer BR, Wolfe RR, Coker RH. Essential Amino Acid Supplement Lowers Intrahepatic Lipid despite Excess Alcohol Consumption. Nutrients 2020; 12:E254. [PMID: 31963802 PMCID: PMC7019240 DOI: 10.3390/nu12010254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/18/2022] Open
Abstract
Excess alcohol consumption is a top risk factor for death and disability. Fatty liver will likely develop and the risk of liver disease increases. We have previously demonstrated that an essential amino acid supplement (EAAS) improved protein synthesis and reduced intrahepatic lipid in the elderly. The purpose of this exploratory pilot study was to initiate the evaluation of EAAS on intrahepatic lipid (IHL), body composition, and blood lipids in individuals with mild to moderate alcohol use disorder (AUD). Following consent, determination of eligibility, and medical screening, 25 participants (18 males at 38 ± 15 years/age and 7 females at 34 ± 18 years/age) were enrolled and randomly assigned to one of two dosages: a low dose (LD: 8 g of EAAS twice/day (BID)) or high dose (HD: 13 g of EAAS BID). Five of the twenty-five enrolled participants dropped out of the intervention. Both groups consumed the supplement BID for 4 weeks. Pre- and post-EAAS administration, IHL was determined using magnetic resonance imaging/spectroscopy, body composition was analyzed using dual-energy X-ray absorptiometry, and blood parameters were measured by LabCorp. T-tests were used for statistical analysis and considered significant at p < 0.05. While there was no significant change in IHL in the LD group, there was a significant 23% reduction in IHL in the HD group (p = 0.02). Fat mass, lean tissue mass, bone mineral content, and blood lipids were not altered. Post-EAAS phosphatidylethanol was elevated and remained unchanged in LD at 407 ± 141 ng/mL and HD at 429 ± 196 ng/mL, indicating chronic and excess alcohol consumption. The HD of the proprietary EAAS formulation consumed BID seemed to lower IHL in individuals with mild to moderate AUD. We suggest that further studies in a larger cohort be conducted to more completely address this important area of investigation.
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Affiliation(s)
- Melynda S. Coker
- Department of Natural Resources and Environment, University of Alaska Fairbanks, 505 South Chandalar Drive, Fairbanks, AK 99775, USA;
| | - Kaylee R. Ladd
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK 99775, USA; (K.R.L.); (J.K.)
| | - Jimin Kim
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK 99775, USA; (K.R.L.); (J.K.)
| | - Carl J. Murphy
- Institute of Arctic Biology, Department of Chemistry & Biochemistry, University of Alaska Fairbanks1930 Yukon Dr. Room 136, Fairbanks, AK 99775, USA;
| | - Ryan DeCort
- Bassett Army Community Hospital, 4076 Neely Road, FortWainwright, United States Army, Fairbanks, AK 99703, USA;
| | - Bradley R. Newcomer
- Honors College, 1501 251Warren Service Drive, Room 105, James Madison University, Harrisonburg, VA 22807, USA;
| | - Robert R. Wolfe
- Department of Geriatrics, Center for Translational Research in Aging & Longevity, Donald W. Reynolds Institute on Aging, 4301 West Markham, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Robert H. Coker
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK 99775, USA; (K.R.L.); (J.K.)
- Institute of Arctic Biology, Department of Chemistry & Biochemistry, University of Alaska Fairbanks1930 Yukon Dr. Room 136, Fairbanks, AK 99775, USA;
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36
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Stenton J, Walther L, Hansson T, Andersson A, Isaksson A. Inter Individual Variation and Factors Regulating the Formation of Phosphatidylethanol. Alcohol Clin Exp Res 2019; 43:2322-2331. [PMID: 31509266 DOI: 10.1111/acer.14195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol use disorders are a major but often unrecognized health problem. Alcohol markers can therefore be of great value for diagnosis, follow-up, and treatment evaluation. Phosphatidylethanol in blood (B-PEth) is an alcohol biomarker with higher clinical sensitivity and specificity than commonly used alcohol markers but has shown a considerable interindividual variation in relation to reported consumption. METHODS An in vitro system was used to investigate factors, which may affect the formation rate of PEth or which may give rise to interindividual variation in the rate of formation. In this system, isolated erythrocytes from 31 individuals were incubated in the presence of various concentrations of ethanol (EtOH). The concentration of PEth and phosphatidylcholine (PC), the parent molecule of PEth, was determined by chromatographic methods. RESULTS Time, EtOH, and PC concentration were major factors determining the amount of PEth formed. The interindividual variation in PEth formation rate, calculated at an EtOH concentration of 50 mmol/l, showed a coefficient of variation (CV) from 23 to 31% for the different PEth forms studied (PEth 16:0/18:2, total PEth and PEth 16:0/18:1). The concentration of PC was found to be an important determinant of this variation. The formation rate for PEth 16:0/18:2 was somewhat higher than for PEth 16:0/18:1. The formation of PEth 16:0/18:1 but not PEth 16:0/18:2 showed a positive correlation to the concentration of PEth at baseline (endogenous PEth). Calculation of enzyme kinetics for the reaction resulting in the formation of PEth 16:0/18:1 or PEth 16:0/18:2 showed an apparent Km (Michaelis constant) of approximately 160 to 170 mmol/l. CONCLUSIONS Interindividual variation in the formation rate of PEth appears to be a significant but relatively modest source of variation in the relation between B-PEth and reported consumption. Correction for interindividual variation in PC concentrations might substantially reduce the interindividual variability in PEth formation and consequently in B-PEth.
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Affiliation(s)
- Joanna Stenton
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Lisa Walther
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Therese Hansson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Anders Andersson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Anders Isaksson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
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Nguyen VL, Fitzpatrick M. Should phosphatidylethanol be currently analysed using whole blood, dried blood spots or both? ACTA ACUST UNITED AC 2019; 57:617-622. [DOI: 10.1515/cclm-2018-0667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/09/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Phosphatidylethanol (PEth) are phospholipids produced through non-oxidative ethanol metabolism. They accumulate in red blood cells and have been traditionally analysed in whole blood as potential biomarkers for moderate to long-term alcohol consumption. More recently, their analysis in dried blood spots has been gaining favour, namely, due to the ease in sampling, transport and storage conditions required. This paper aims at providing a short comparative review between analysing PEth in whole blood and dried blood spots and the potential pitfalls that researchers may face when setting up PEth testing for clinical use.
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Lowery EM, Walsh M, Yong M, Kovacs EJ, Joyce C, Afshar M. Use of alcohol biomarkers to identify alcohol misuse in organ donors. Alcohol 2018; 73:67-72. [PMID: 30312857 PMCID: PMC6188836 DOI: 10.1016/j.alcohol.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
Phosphatidylethanol is a direct alcohol biomarker for identifying alcohol misuse. It carries several advantages over other alcohol biomarkers, including a detection half-life of several weeks and little confounding by patient characteristics or organ dysfunction. The aim of this study is to derive an optimal phosphatidylethanol cut point to identify organ donors with alcohol misuse, and to assess the impact of alcohol misuse on organ allocation. Discrimination of phosphatidylethanol was evaluated using the area under the ROC curve from a mixed effects logistic regression model. Phosphatidylethanol had an area under the ROC curve of 0.89 (95% CI 0.80-0.98). A phosphatidylethanol cut point of ≥84 ng/mL provided optimal discrimination for the identification of alcohol misuse with a sensitivity of 75% (95% CI 52.9%-89.4%) and a specificity of 97% (95% CI 91%-99%), a positive predictive value of 82% (95% CI 59%-94%), and a negative predictive value of 95% (95% CI 89%-98%). In deceased organ donors who had been critically ill, phosphatidylethanol had good test characteristics to discriminate alcohol misuse. Other alcohol biomarkers performed poorly in deceased organ donors. Liver allocation was decreased in donors with alcohol misuse by proxy history, but not in those with phosphatidylethanol >84 ng/mL, revealing possible information bias in liver allocation.
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Affiliation(s)
- Erin M Lowery
- Alcohol Research Program, Loyola University Chicago Health Science Division, Maywood, IL, United States; Division of Pulmonary and Critical Care, Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States.
| | - Martin Walsh
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
| | - Meagan Yong
- Alcohol Research Program, Loyola University Chicago Health Science Division, Maywood, IL, United States
| | - Elizabeth J Kovacs
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cara Joyce
- Alcohol Research Program, Loyola University Chicago Health Science Division, Maywood, IL, United States
| | - Majid Afshar
- Alcohol Research Program, Loyola University Chicago Health Science Division, Maywood, IL, United States; Division of Pulmonary and Critical Care, Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
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Nguyen VL, Seth D. Letter to the Editor Regarding Afshar et al. (2017): Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients. Alcohol Clin Exp Res 2018; 42:2061-2063. [PMID: 30059168 DOI: 10.1111/acer.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Van Long Nguyen
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Devanshi Seth
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Centenary Institute of Cancer Medicine and Cell Biology (DS), The University of Sydney, NSW, Australia
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Simon TW. Providing context for phosphatidylethanol as a biomarker of alcohol consumption with a pharmacokinetic model. Regul Toxicol Pharmacol 2018; 94:163-171. [DOI: 10.1016/j.yrtph.2018.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/29/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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