Ethyl Glucuronide in Hair Compared With Traditional Alcohol Biomarkers-A Pilot Study of Heavy Drinkers Referred to an Alcohol Detoxification Unit

Comparative analysis between CDT in serum and Ethyl glucuronide in hair to define the best reliable tool for the diagnosis of alcohol abuse

The increase in alcohol consumption in society has not only led to a number of medical issues but has also become a matter of considerable legal importance. Thus, there is both scientific interest and the necessity to diagnose alcohol abuse in the application of the provisions of the law through laboratory tests that ensure maximum objectivity. The purpose of this work is to study and compare the diagnostic performance of two of the main markers of alcohol abuse, serum carbohydrate-deficient transferrin (CDT) and Ethyl glucuronide (EtG) in a group of 336 driving under the influence (DUI) of alcohol offenders. Thus, it is possible to establish the best marker of alcohol consumption in order to assess the fitness to drive of DUI subjects.EtG was detected in 55 hair samples, while CDT was detected in 5 blood samples. Of the EtG-positive subjects 96,4% had CDT values below the cut-off. While CDT refers to an alcohol consumption of approximately the previous 10 days, EtG allows to detect an excessive alcohol consumption of the last few months. Because of these two different time-windows, EtG proves to be more reliable, since it is more difficult for subjects to change their drinking practice to test negative to toxicological analysis. The determination of Ethyl glucuronide on hair matrix is a valuable tool for the diagnosis of alcohol abuse, with high sensitivity and specificity and certainly greater reliability than traditional markers such as CDT, being a direct marker of alcohol consumption.

Does ethyl glucuronide in hair correlate with alcohol consumption? A comparative study with other traditional biomarkers among individuals with alcohol dependence syndrome

AIM

Ethyl glucuronide (EtG) in hair is a direct biomarker proven to be useful for the detection of chronic excessive alcohol use. This study investigated the association of self-reported alcohol consumption with traditional biomarkers: GGT, AST, ALT, CDT, and MCV in blood and a direct biomarker, hair EtG, in a total of 122 patients with alcohol dependence syndrome. The diagnostic accuracy of the biomarkers to differentiate heavy from non-heavy drinkers was also evaluated.

METHOD

GGT, AST, and ALT in serum were measured by Automated Chemistry Analyzer, MCV in blood was measured by Haematology Analyzer, serum CDT was analyzed by ELISA, and EtG in hair was evaluated by gas chromatography-mass spectrometry. The association between the biomarkers and the amount of alcohol consumed (self-reported) was determined using Spearman's rank correlation.

RESULTS

All participants showed EtG level above the cut-off (0.03 ng/mg). Hair EtG showed a statistically significant linear and positive correlation with the amounts (in grams) of alcohol consumed (r = 0.60; p < 0.001). No correlation was observed among the traditional biomarkers and the quantity of alcohol consumed. Also, EtG showed an excellent receiver operating characteristic (ROC) curve (98%) with good sensitivity (85%) and specificity (60%) to classify heavy drinkers among individuals with alcohol dependence syndrome.

CONCLUSION

Hair EtG can be helpful to estimate retrospective alcohol consumption in long-term chronic alcohol consumption cases. Hair EtG also provides a reliable diagnostic test to detect heavy drinkers among individuals with alcohol dependence syndrome.

A Review on Flexible Electrochemical Biosensors to Monitor Alcohol in Sweat

The continued focus on improving the quality of human life has encouraged the development of increasingly efficient, durable, and cost-effective products in healthcare. Over the last decade, there has been substantial development in the field of technical and interactive textiles that combine expertise in electronics, biology, chemistry, and physics. Most recently, the creation of textile biosensors capable of quantifying biometric data in biological fluids is being studied, to detect a specific disease or the physical condition of an individual. The ultimate goal is to provide access to medical diagnosis anytime and anywhere. Presently, alcohol is considered the most commonly used addictive substance worldwide, being one of the main causes of death in road accidents. Thus, it is important to think of solutions capable of minimizing this public health problem. Alcohol biosensors constitute an excellent tool to aid at improving road safety. Hence, this review explores concepts about alcohol biomarkers, the composition of human sweat and the correlation between alcohol and blood. Different components and requirements of a biosensor are reviewed, along with the electrochemical techniques to evaluate its performance, in addition to construction techniques of textile-based biosensors. Special attention is given to the determination of biomarkers that must be low cost and fast, so the use of biomimetic materials to recognize and detect the target analyte is turning into an attractive option to improve electrochemical behavior.

The Association between the Alcohol Biomarker Phosphatidylethanol (PEth) and Self-Reported Alcohol Consumption among Russian and Norwegian Medical Patients

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.

Ethyl glucuronide hair testing: A review

Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite that can be detected in several matrices (e.g. blood, urine, hair, meconium) for variable periods of time. Quantification of EtG in hair (hEtG) has established itself, over recent years, as one of the most reliable biomarkers of long-term alcohol consumption habits, with the Society of Hair Testing (SoHT) offering cut-off values for assessment of both abstinence and heavy drinking (>60 g/day). Despite its high diagnostic performance, however, issues concerning inter- and intra-laboratory variability as well as data interpretation are still being investigated and represent the ultimate barrier to widespread acceptance of hEtG in the forensic context. The aim of this review is to summarize currently available analytical methods of hEtG testing, provide a framework to understand current hEtG cut-offs and their possible upcoming changes (in particular, a lower abstinence cut-off has been proposed for the 2019 revision of the SoHT consensus), and offer a schematic but exhaustive overview of the pitfalls in result reproducibility and interpretation that may limit applications of hEtG testing in the forensic context. Ultimately, the purpose of the authors is not to undermine the reliability of hEtG as an alcohol use marker, but rather to enhance it by promoting familiarization with all aspects related to it, from ethanol pharmacokinetics and EtG incorporation into hair, to sample preparation and analytical methods, to specific cases warranting close attention and additional tests for correct interpretation of hEtG results.

Biomarkers of alcohol misuse: recent advances and future prospects

Alcohol abuse and dependence are highly prevalent in many cultures and contribute considerably to the global burden of health and social issues. The current inability to accurately characterise long-term drinking behaviours is a major obstacle to alcoholism diagnosis and treatment. Therefore, it is of great importance to develop objective diagnostic tools to discern subjects with excessive alcohol use and alcoholism or to confirm abstinence. Research over past years has revealed several biochemical compounds with considerable potential for accurate reflection of alcohol intake. This review will address the issue of alcohol biomarker definition, the types of molecules used as so-called traditional biomarkers, and the compounds that can serve as novel biomarker candidates or components of biomarker panels.

Alternative sampling strategies for the assessment of alcohol intake of living persons

Monitoring of alcohol consumption by living persons takes place in various contexts, amongst which workplace drug testing, driving under the influence of alcohol, driving licence regranting programs, alcohol withdrawal treatment, diagnosis of acute intoxication or fetal alcohol ingestion. The matrices that are mostly used today include blood, breath and urine. The aim of this review is to present alternative sampling strategies that allow monitoring of the alcohol consumption in living subjects. Ethanol itself, indirect (carbohydrate deficient transferrin, CDT%) as well as direct biomarkers (ethyl glucuronide, EtG; ethyl sulphate, EtS; fatty acid ethyl esters, FAEEs and phosphatidylethanol species, PEths) of ethanol consumption will be considered. This review covers dried blood spots (CDT%, EtG/EtS, PEths), dried urine spots (EtG/EtS), sweat and skin surface lipids (ethanol, EtG, FAEEs), oral fluid (ethanol, EtG), exhaled breath (PEths), hair (EtG, FAEEs), nail (EtG), meconium (EtG/EtS, FAEEs), umbilical cord and placenta (EtG/EtS and PEth 16:0/18:1). Main results, issues and considerations specific to each matrix are reported. Details about sample preparation and analytical methods are not within the scope of this review.

Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation

Context:

A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol.

Objective:

In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX.

Design:

Cross-sectional survey.

Setting:

Psychosomatic evaluation.

Patients:

Seventy patients with ALD prior to listing for an LTX.

Interventions:

According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70).

Main Outcome Measures:

The analysis of hETG by liquid chromatography–mass spectrometry, clinical interview.

Results:

By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption.

Conclusions:

Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient’s situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.

Ethyl glucuronide concentrations in hair: a controlled alcohol-dosing study in healthy volunteers

Ethyl glucuronide (EtG) is a minor phase II metabolite of alcohol that accumulates in hair. It has been established as a sensitive marker to assess the retrospective consumption of alcohol over recent months using a cut-off of ≥7 pg/mg hair to assess repeated alcohol consumption. The primary aim was to assess whether amounts of alcohol consumed correlated with EtG concentrations in hair. Additionally, we investigated whether the current applied cut-off value of 7 pg/mg hair was adequate to assess the regular consumption of low-to-moderate amounts of alcohol. A prospective controlled alcohol-dosing study in 30 healthy individuals matched on age and gender. Individuals were instructed to drink no alcohol (N = 10), 100 g alcohol per week (N = 10) or 150 g alcohol per week (N = 10) for 12 consecutive weeks, before and after which hair was collected. Throughout the study, compliance to daily alcohol consumption was assessed by analyzing urine EtG three times weekly. Participants in the non-drinking group had median EtG concentrations of 0.5 pg/mg hair (interquartile range (IQR) 1.7 pg/mg; range < 0.21-4.5 pg/mg). Participants consuming 100 and 150 g alcohol per week showed median EtG concentrations of 5.6 pg/mg hair (IQR 4.7 pg/mg; range 2.0-9.8 pg/mg) and 11.3 pg/mg hair (IQR 5.0 pg/mg; range 7.7-38.9 pg/mg), respectively. Hair EtG concentrations between the three study groups differed significantly from one another (p < 0.001). Hair EtG concentrations can be used to differentiate between repeated (low-to-moderate) amounts of alcohol consumed over a long time period. For the assessment of repeated alcohol use, we propose that the current cut-off of 7 pg/mg could be re-evaluated.

Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: role of gender differences

BACKGROUND

Ethyl glucuronide (EtG) is a minor alcohol metabolite that accumulates in hair and is proposed as a stable marker for the detection of chronic and excessive alcohol consumption above a cut-off level of 30pg/mg hair. A correlation between drinking behavior and EtG hair concentrations is observed, but large variability exists.

AIMS

To investigate the correlation between alcohol consumption and hair EtG concentrations in alcohol dependent patients, and the effect of gender differences as a factor for the variability on this correlation.

METHODS

EtG was measured by gas chromatography coupled to mass spectrometry in the hairs (first 3cm) of 36 alcohol dependent patients (25 males/11 females) starting and alcohol detoxification program. Factors that possibly influence EtG content in hair (except age and gender) were excluded. Detailed retrospective alcohol consumption was obtained over the last 3 months using the Timeline Follow Back interview.

RESULTS

Median total alcohol consumption over 3 months was 13,050g pure alcohol (range 60-650g/day). Hair EtG concentrations varied between 32 and 662pg/mg. There was a statistically significant linear and positive correlation between hair EtG and amounts of alcohol consumed (Pearson r=0.83; p<0.001), in both males (Pearson r=0.83; p<0.001) and females (Pearson r=0.76; p=0.007).

CONCLUSIONS

There is a linear correlation, with no significant effect of gender, between hair EtG concentrations and amounts of alcohol consumed in alcohol-dependent individuals. Analysis of EtG in hair can be applied to estimate retrospective alcohol consumption in both male and female alcohol dependent subjects using the same cut-off.

Determination of ethyl glucuronide in hair improves evaluation of long-term alcohol abstention in liver transplant candidates

BACKGROUND & AIMS

Prior to listing patients for Orthotopic liver transplantation (OLT) an abstention period of 6 months is required. Ethyl glucuronide in the hair is a new reliable marker for the assessment of alcohol consumption. Here, the diagnostic value of determining the ethyl glucuronide concentration in the hair of liver transplant candidates was evaluated.

METHODS

In 63 transplant candidates with alcoholic liver cirrhosis and 25 control patients with cirrhosis of other aetiologies alcohol markers, i.e. hEtG, urine EtG, blood ethanol, methanol and carbohydrate deficient transferrin were determined in parallel to an interview with a psychologist.

RESULTS

A total of 19 (30%) transplant candidates admitted alcohol consumption within the last 6 months, while 39/63 (62%) were positive for at least one alcohol marker. In 52% of the 44 candidates denying alcohol consumption, abstention was disproved by detecting at least one positive alcohol marker, in 83% of cases by a positive hEtG result. In the control patients stating abstention from alcohol all hEtG tests were negative. No impact of renal or liver function on hEtG results was detected. A specificity of 98% and a positive predictive value of 92% were calculated for testing hEtG in proximal hair segment and applying a cut-off of 30 pg/mg.

CONCLUSIONS

In 52% of patients denying alcohol consumption within the last 6 months, alcohol abstention was disproved, in 83% of cases by hEtG testing. Therefore, hEtG is a promising new marker for the evaluation of long-term alcohol abstention in liver transplant candidates.

Ethylglucuronide in hair is a top predictor of impaired driving recidivism, alcohol dependence, and a key marker of the highest BAC interlock tests

OBJECTIVES

This study focuses on the predictive and comparative significance of ethyl glucuronide measured in head hair (hEtG) for estimating risks associated with alcohol-impaired driving offenders. Earlier work compared different alcohol biomarkers for estimating rates of failed blood alcohol concentration (BAC) tests logged during 8 months of interlock participation. These analyses evaluate the comparative performance of several alcohol markers including hEtG and other markers, past driver records, and psychometric assessment predictors for the detection of 4 criteria: new driving under the influence (DUI) recidivism, alcohol dependence, and interlock record variables including fail rates and maximal interlock BACs logged.

METHODS

Drivers charged with alcohol impairment (DUI) in Alberta, Canada (n = 534; 64% first offenders, 36% multiple offenders) installed ignition interlock devices and consented to participate in research to evaluate blood-, hair-, and urine-derived alcohol biomarkers; sit for interviews; take psychometric assessments; and permit analyses of driving records and interlock log files. Subject variables included demographics, alcohol dependence at program entry, preprogram prior DUI convictions, postenrollment new DUI convictions, self-reported drinking assessments, morning and overall rates of failed interlock BAC tests, and maximal interlock BAC readings. Recidivism, dependence, high BAC, and combined fail rates were set as criteria; other variables were set as predictors. Area under the receiver operating characteristics (ROC) curve (A') estimates of sensitivity and specificity were calculated. Additional analyses were conducted on baseline hEtG levels. Driver performance and drinking indicators were evaluated against the standard hEtG cutoff for excessive drinking at (30 pg/mg) and a higher criterion of 50 pg/mg. HEtG splits were evaluated with the Mann-Whitney rank statistic.

RESULTS

HEtG emerged as a top overall predictor for discriminating new recidivism events that occur after interlock installation, for entry alcohol dependence, and for the highest interlock BACs recorded. Together, hEtG and phosphatidylethanol (PEth) were the top predictors of all criterion measures. By contrast, the hair-derived alcohol biomarkers hEtG and hFAEE (fatty acid ethyl esters) were poorer than other alcohol biomarkers as detectors of interlock BAC test fail rates.

CONCLUSIONS

This study showed that hEtG, an objective alternative to often unreliable self-reported past representation of drinking levels, yields crucial insight into driver alcohol-related risks early in an interlock program and is a top predictor of new recidivist events. Together with PEth, these markers would be excellent anchors in a panel for detecting alcohol consumption.

Ethyl glucuronide and ethyl sulfate

Alcohol misuse is associated with significant morbidity and mortality. Although clinical history, examination, and the use of self-report questionnaires may identify subjects with harmful patterns of alcohol use, denial or under-reporting of alcohol intake is common. Existing biomarkers for detecting alcohol misuse include measurement of blood or urine ethanol for acute alcohol consumption, and carbohydrate-deficient transferrin and gamma-glutamyl transferase for chronic alcohol misuse. There is a need for a biomarker that can detect excessive alcohol consumption in the timeframe between 1 day and several weeks. Ethyl glucuronide (EtG) is a direct metabolite of ethanol detectable in urine for up to 90 h and longer in hair. Because EtG has high specificity for excess alcohol intake, it has great potential for use in detecting "binge" drinking. Using urine or hair, this noninvasive marker has a role in a variety of clinical and forensic settings.

Immune response to acetaldehyde-human serum albumin adduct among healthy subjects related to alcohol intake

Acetaldehyde (AA) is the main metabolic product in ethanol metabolism, although it can also derive from sources of airborne pollution. As a typical aldehyde, AA is able to react with a variety of molecular targets, including DNA and protein. This property justifies the hypothesis of a immune reaction against this kind of adduct, to be studied by a seroprevalence screening approach. In this study, the correlation between drinking habits and the amount of circulating AA-human serum albumin adduct (AA-HSA) was evaluated in a group of healthy subjects, non alcohol-addicted. Daily ethanol intake (grams) was inferred for each subject using the information collected through a questionnaire, and AA-HSA antibodies (AA-HSA ab) analyses were performed using the Displacement Assay on whole blood samples. The findings showed a correlation between ethanol intake and immune response to molecular adduct. These results underscore the evaluation of AA-HSA ab amount as a suitable molecular marker for alcohol intake that can be applied in future investigations on a large scale for prevention screening.

Assessing the drinking status of liver transplant patients with alcoholic liver disease

The accurate assessment of drinking by patients with alcoholic liver disease is important both before and after liver transplantation. Unfortunately, self-reports by these individuals often underestimate their actual alcohol consumption. Several recently developed biochemical measures can provide additional information on a patient's use of alcohol. This article describes ethyl glucuronide, ethyl sulfate, phosphatidyl ethanol, and carbohydrate-deficient transferrin as biomarkers of drinking and summarizes research dealing with their application in patients with alcohol use disorders who are candidates for or recipients of liver transplantation. The article also offers suggestions for enhancing the reliability of self-report measures of drinking status.

Multivariate strategies for screening evaluation of harmful drinking

Background: A chemometric class modeling strategy (unequal dispersed classes [UNEQ]) is applied for the first time to evaluate harmful alcohol drinking within large population screening programs, in comparison with traditional strategies of data interpretation. Five inexpensive indirect biomarkers (aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, mean corpuscular volume and carbohydrate-deficient transferrin) were determined in blood samples from 423 patients, classified as low-risk or harmful drinkers, according to their ethanol consumption. Results: The multivariate UNEQ approach remarkably improves the diagnostic performances of indirect biomarkers in harmful drinking evaluation, leading to reliable decision rules, with few doubtful classifications to be reviewed through complex confirmation procedures. Conclusion: This UNEQ model represents an innovative general approach for clinical evaluation that efficiently extracts the information content present in each biomarker to provide a new synthetic multivariate parameter, to be directly used in diagnostic protocols.

Protein biomarkers of alcohol abuse

Alcohol abuse can lead to a number of health and social issues. Our current inability to accurately assess long-term drinking behaviors is an important obstacle to its diagnosis and treatment. Biomarkers for chronic alcohol consumption have made a number of important advances but have yet to become highly accurate and as accepted as objective tests for other diseases. Thus, there is a crucial need for the development of more sensitive and specific markers of alcohol abuse. Recent advancements in proteomic technologies have greatly increased the potential for alcohol abuse biomarker discovery. Here, the authors review established and novel protein biomarkers for long-term alcohol consumption and the proteomic technologies that have been used in their study.

Non-oxidative ethanol metabolites as a measure of alcohol intake

Recent alcohol intake can be monitored by the measurement of indirect biomarkers. Elevated levels of liver enzymes (i.e. gamma-glutamyl transferase (GGT), alanine amino transferase (ALT) and aspartate amino transferase (AST)) in blood are commonly used in clinical practice as an indicator of alcohol-induced liver damage. With the exception of carbohydrate-deficient transferrin (CDT), the specificity of indirect markers is only moderate because many cases of elevated levels are unrelated to alcohol consumption. Because of their intermediate half-life and tendency to accumulate in hair, non-oxidative ethanol metabolites can be used as markers with an intermediate timeframe between ethanol measurements and GGT and CDT with regard to recent alcohol consumption occurring between hours to 1 week. Additionally, these biomarkers offer a high ethanol-specificity in combination with approximately a two-fold higher sensitivity in comparison with indirect alcohol markers. In case of forensic use of direct ethanol metabolites, caution has to be taken in interpretation and pre-analytical pitfalls should be considered.

Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis

The present paper aims at a systematic review of the current knowledge on phosphatidylethanol (PEth) in blood as a direct marker of chronic alcohol use and abuse. In March 2012, the search through “MeSH” and “free-text” protocols in the databases Medline/PubMed, SCOPUS, Web of Science, and Ovid/Embase, combining the terms phosphatidylethanol and alcohol, provided 444 records, 58 of which fulfilled the inclusion criteria and were used to summarize the current evidence on the formation, distribution and degradation of PEth in human blood: (1), the presence and distribution of different PEth molecular species (2), the most diffused analytical methods devoted to PEth identification and quantization (3), the clinical efficiency of total PEth quantification as a marker of chronic excessive drinking (4), and the potential utility of this marker for identifying binge drinking behaviors (5). Twelve papers were included in the meta-analysis and the mean (M) and 95% confidence interval (CI) of total PEth concentrations in social drinkers (DAI ≤ 60 g/die; M = 0.288 μM; CI 0.208–0.367 μM) and heavy drinkers (DAI > 60 g/die; M = 3.897 μM; CI 2.404–5.391 μM) were calculated. The present analysis demonstrates a good clinical efficiency of PEth for detecting chronic heavy drinking.

Comparison of ethyl glucuronide in hair with self-reported alcohol consumption

AIMS

Ethyl glucuronide (EtG) in hair is a proposed biomarker for alcohol consumption. This study compares hair EtG concentrations with self-reported alcohol consumption data, in individuals with a range of alcohol use.

METHODS

Hair was collected from 100 participants with a range of alcohol use. Participants completed an Alcohol Use Disorders Identification Test C questionnaire to record alcohol consumption. Participants were categorized into one of the four groups: tee-totallers (consuming 0 units a week), lower-risk drinkers (1-21 units a week), increasing-risk drinkers' consuming (22-50 units a week) and high-risk drinkers (over 50 units a week). Hair from the proximal 3 cm was analysed for EtG using gas chromatography-mass spectrometry/mass spectrometry.

RESULTS

EtG was detected in 29 out of 100 hair samples. Based on the Society of Hair Testing (SOHT) threshold of 30 pg/mg EtG, the hair test identified alcohol consumption in 57.9% of high-risk drinkers, 45.5% of increasing-risk drinkers and only 9.8% of lower-risk drinkers. EtG sensitivity was highest for high-risk drinkers (consuming more than 50 units a week), identified to be 0.52 using a 30 pg/mg threshold and 0.58 using a 45 pg/mg threshold. A positive result is highly likely to indicate any drinking (positive predictive value, 1.00). A negative result does not provide good evidence for abstinence (negative predictive value, 0.23).

CONCLUSIONS

EtG has been identified to be a low sensitivity marker that cannot be used quantitatively to determine alcohol exposure. EtG can be used qualitatively to indicate alcohol consumption with a positive result providing strong evidence for an individual drinking within the past 3 months.

Levels and types of alcohol biomarkers in DUI and clinic samples for estimating workplace alcohol problems

Widespread concern about illicit drugs as an aspect of workplace performance potentially diminishes attention on employee alcohol use. Alcohol is the dominant drug contributing to poor job performance; it also accounts for a third of the worldwide public health burden. Evidence from public roadways--a workplace for many--provides an example of work-related risk exposure and performance lapses. In most developed countries, alcohol is involved in 20-35% of fatal crashes; drugs other than alcohol are less prominently involved in fatalities. Alcohol biomarkers can improve detection by extending the timeframe for estimating problematic exposure levels and thereby provide better information for managers. But what levels and which markers are right for the workplace? In this paper, an established high-sensitivity proxy for alcohol-driving risk proclivity is used: an average eight months of failed blood alcohol concentration (BAC) breath tests from alcohol ignition interlock devices. Higher BAC test fail rates are known to presage higher rates of future impaired-driving convictions (driving under the influence; DUI). Drivers in alcohol interlock programmes log 5-7 daily BAC tests; in 12 months, this yields thousands of samples. Also, higher programme entry levels of alcohol biomarkers predict a higher likelihood of failed interlock BAC tests during subsequent months. This paper summarizes the potential of selected biomarkers for workplace screening. Markers include phosphatidylethanol (PEth), percent carbohydrate deficient transferrin (%CDT), gammaglutamyltransferase (GGT), gamma %CDT (γ%CDT), and ethylglucuronide (EtG) in hair. Clinical cut-off levels and median/mean levels of these markers in abstinent people, the general population, DUI drivers, and rehabilitation clinics are summarized for context.

Chronic excessive alcohol consumption diagnosis: comparison between traditional biomarkers and ethyl glucuronide in hair, a study on a real population

BACKGROUND

The study aimed to evaluate the diagnostic sensitivity (SE) and specificity (SP) of chronic alcohol misuse diagnosis by comparing traditional biomarkers with ethyl glucuronide (EtG), an ethanol direct metabolite, detected in the keratinic matrix.

METHODS

Seventy-six subjects tested for chronic alcohol abuse for different purposes were recruited. EtG was detected in hair, whereas the analyses of carbohydrate-deficient transferrin (CDT), alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, mean corpuscular volume, and mean corpuscular hemoglobin were performed in serum samples.

RESULTS

Of the 76 patients examined, 26 were judged by the medical doctors as subjects with alcohol abuse problems and, therefore, not eligible for driving license renewal or liver transplant. EtG in hair (SE = 0.68, SP = 1.00) showed the best diagnostic SE and SP compared with the other biomarkers investigated. Among the traditional biomarkers, only CDT proved to be suitable for forensic purposes because of the high diagnostic specificity (SP = 1.00) although it showed poor diagnostic SE (0.27). The percentage of positive samples decreased for all the biomarkers by excluding the subjects with hepatic diseases, except for EtG and CDT, suggesting that these 2 biomarkers could be less affected by false positive results, because of hepatic diseases.

CONCLUSIONS

This study showed that when EtG in hair and CDT results are combined, diagnostic SE in chronic alcohol abuse diagnosis clearly improved, suggesting that complementary analysis of both these biomarkers provides the best diagnostic tool in suspected cases of chronic excessive alcohol consumption.

Determination of ethyl glucuronide in nails by liquid chromatography tandem mass spectrometry as a potential new biomarker for chronic alcohol abuse and binge drinking behavior

A liquid chromatography tandem mass spectrometry method for ethyl glucuronide (EtG) detection and quantification in nails was developed and fully validated. Nails were extracted in 700 μL double-distilled water. EtG-d(5) was used as an internal standard. Reversed-phase separation was obtained with an isocratic mobile phase composed of 0.1% formic acid and acetonitrile (99:1) for 10 min. Quantification was performed by multiple reaction monitoring of two transitions per compound (EtG and internal standard). The assay was linear from 10 to 500 pg/mg. Validation parameters were studied at three different quality control levels (10, 50, and 300 pg/mg). Intraday, interday, and total imprecision had a coefficient of variation of less than 9.5%. Ion suppression and ion enhancement were negligible (less than 20%). No carryover was detected. The method was applied to several real cases, among teetotalers, social drinkers, and heavy drinkers. A questionnaire, together with the informed consent form, was given to all the participants in order to evaluate alcohol intake in the one month before sample collection. Nail EtG levels in a social drinker were much higher than the concentrations of EtG in hair provided by the same subject, thus suggesting potential high sensitivity in evaluating both chronic excessive alcohol consumption and binge drinking habits.

Ethyl glucuronide

Alcohol is associated with significant morbidity and mortality. Subjects abusing alcohol can be identified through clinical history, examination or self-report questionnaires. A range of biomarkers is available for detecting alcohol misuse, but there is still a need for a marker that can detect alcohol consumption in the time window between one day (ethanol) and one week (gamma-glutamyl transpeptidase and carbohydrate-deficient transferrin). Ethyl glucuronide is a direct metabolite that can be detected in urine for up to 90 h and has the potential to become a useful marker of 'binge' drinking. As a non-invasive marker, it could have a role in a variety of clinical and forensic settings.

A double-blind, placebo-controlled trial to assess the efficacy of quetiapine fumarate XR in very heavy-drinking alcohol-dependent patients

BACKGROUND

Despite advances in developing medications to treat alcohol dependence, few such medications have been approved by the Food and Drug Administration. Identified molecular targets are encouraging and can lead to the development and testing of new compounds. Atypical antipsychotic medications have been explored with varying results. Prior research suggests that the antipsychotic quetiapine may be beneficial in an alcohol-dependent population of very heavy drinkers.

METHODS

In this double-blind, placebo-controlled trial, 224 alcohol-dependent patients who reported very heavy drinking were recruited across 5 clinical sites. Patients received either quetiapine or placebo and Medical Management behavioral intervention. Patients were stratified on gender, clinical site, and reduction in drinking prior to randomization.

RESULTS

No differences between the quetiapine and placebo groups were detected in the primary outcome, percentage heavy-drinking days, or other drinking outcomes. Quetiapine significantly reduced depressive symptoms and improved sleep but had no effect on other nondrinking outcomes. Results from a subgroup analysis suggest that patients who reduced their drinking prior to randomization had significantly better drinking outcomes during the maintenance phase (p < 0.0001). No significant interactions, however, were observed between reducer status and treatment group. Finally, quetiapine was generally well tolerated. Statistically significant adverse events that were more common with quetiapine versus placebo include dizziness (14 vs. 4%), dry mouth (32 vs. 9%), dyspepsia (13 vs. 2%), increased appetite (11 vs. 1%), sedation (15 vs. 3%), and somnolence (34 vs. 9%).

CONCLUSIONS

This multisite clinical trial showed no efficacy for quetiapine compared with placebo at reducing alcohol consumption in heavy-drinking alcohol-dependent patients.

Hair: a complementary source of bioanalytical information in forensic toxicology

Hair has been used for years in the assessment and documentation of human exposure to drugs, as it presents characteristics that make it extremely valuable for this purpose, namely the fact that sample collection is performed in a noninvasive manner, under close supervision, the possibility of collecting a specimen reflecting a similar timeline in the case of claims or suspicion of a leak in the chain of custody, and the increased window of detection for the drugs. For these reasons, testing for drugs in hair provides unique and useful information in several fields of toxicology, from which the most prominent is the possibility of studying individual drug use histories by means of segmental analysis. This paper will review the unique role of hair as a complementary sample in documenting human exposure to drugs in the fields of clinical and forensic toxicology and workplace drug testing.

Pregnancy and variations of carbohydrate-deficient transferrin levels measured by the candidate reference HPLC method

AIMS

Contrasting data are available on the diagnostic accuracy of carbohydrate-deficient transferrin (CDT) during pregnancy. These differences may depend in part on how CDT was evaluated and expressed. Here, we report on variations of CDT levels in pregnant women using the high performance liquid chromatography (HPLC) candidate reference method.

METHODS

Alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, mean corpuscular volume, serum transferrin, urine and serum ethyl glucuronide and CDT were measured in 64 women, self-reporting as non-alcohol abusers (age: median 34, IQR: 28-38), at different stages of normal pregnancy (gestational weeks: median 28, IQR: 8-33). CDT was expressed as percentage of disialotransferrin to total transferrin (%CDT).

RESULTS

Transferrin was associated with both %CDT (r = 0.66; P < 0.001) and gestational week (r = 0.68; P < 0.001). Interestingly, %CDT was highly correlated with gestational week (r = 0.77; P < 0.001), even after controlling for the effect of transferrin. Moreover, statistically significant differences in %CDT were also evident between women grouped for pregnancy trimester (first trimester: mean 1.01% (SD 0.19); second trimester: 1.30% (SD 0.14); third trimester: 1.53% (SD 0.22); ANOVA P < 0.001). Trend analysis confirmed a proportional increase of %CDT along with pregnancy trimesters (P < 0.001).

CONCLUSIONS

%CDT, measured with the HPLC candidate reference method, is independently associated with gestational week. Differently from what has been previously reported or expected, the relationship between pregnancy and CDT could be more complex. The diagnostic accuracy of CDT for detecting alcohol abuse in a legal context may be limited in pregnant women and the effect of gestational age should be considered.