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Jones AW. Brief history of the alcohol biomarkers CDT, EtG, EtS, 5-HTOL, and PEth. Drug Test Anal 2024; 16:570-587. [PMID: 37806783 DOI: 10.1002/dta.3584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
This article traces the historical development of various biomarkers of acute and/or chronic alcohol consumption. Much of the research in this domain of clinical and laboratory medicine arose from clinics and laboratories in Sweden, as exemplified by carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth). Extensive studies of other alcohol biomarkers, such as ethyl glucuronide (EtG), ethyl sulfate (EtS), and 5-hydroxytryptophol (5-HTOL), also derive from Sweden. The most obvious test of recent drinking is identification of ethanol in a sample of the person's blood, breath, or urine. However, because of continuous metabolism in the liver, ethanol is eliminated from the blood at a rate of 0.15 g/L/h (range 0.1-0.3 g/L/h), so obtaining positive results is not always possible. The widow of detection is increased by analysis of ethanol's non-oxidative metabolites (EtG and EtS), which are more slowly eliminated from the bloodstream. Likewise, an elevated ratio of serotonin metabolites in urine (5-HTOL/5-HIAA) can help to disclose recent drinking after ethanol is no longer measurable in body fluids. A highly specific biomarker of hazardous drinking is CDT, a serum glycoprotein (transferrin), with a deficiency in its N-linked glycosylation. Another widely acclaimed biomarker is PEth, an abnormal phospholipid synthesized in cell membranes when people drink excessively, having a long elimination half-life (median ~6 days) during abstinence. Research on the subject of alcohol biomarkers has increased appreciably and is now an important area of drug testing and analysis.
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Affiliation(s)
- Alan Wayne Jones
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
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Archer AJ, Phillips J, Subhani M, Ward Z, Gordon FH, Hickman M, Dhanda AD, Abeysekera KWM. Proactive case finding of alcohol-related liver disease in high-risk populations: A systematic review. Liver Int 2024; 44:1298-1308. [PMID: 38456654 DOI: 10.1111/liv.15895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Alcohol-related liver disease (ARLD) is often diagnosed at a late stage when mortality is unacceptably high. Earlier identification of ARLD may lead to reduced alcohol intake, participation in hepatocellular carcinoma surveillance and reduction in liver-related morbidity and mortality. People with alcohol use disorder (AUD) are at highest risk of ARLD. The aim of this systematic review was to understand the yield of proactive screening for ARLD amongst high-risk groups. METHODS Embase, Medline, Scopus and grey literature were searched for studies describing proactive assessment for alcohol-related liver disease in people with a history of alcohol excess or diagnosed AUD. Outcomes of interest were fibrosis and cirrhosis detection rates, clinical outcomes, portal hypertension evaluation, attendance at follow-up and cost-effectiveness. RESULTS Fifteen studies were identified for inclusion from 1115 returned by the search. Four key settings for patient engagement were identified as inpatient addiction services, outpatient addiction services, general acute hospital admissions and community outreach. Of these, acute hospital admissions were the highest yield for cirrhosis at 10.8%-29.6% and community outreach the lowest was 1.2%-2.3%. CONCLUSIONS Targeted fibrosis assessment of high-risk populations for ARLD is feasible to conduct and identifies a proportion of patients at risk of advanced liver disease. The highest yield is amongst inpatients admitted with AUD. Prospective work is needed to establish which are the most effective and acceptable screening methods and the impact on long-term outcomes.
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Affiliation(s)
- Ann J Archer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Liver Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston Trust, Bristol, UK
| | - Jennifer Phillips
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Liver Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston Trust, Bristol, UK
| | - Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fiona H Gordon
- Department of Liver Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston Trust, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashwin D Dhanda
- Hepatology Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Kushala W M Abeysekera
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Liver Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston Trust, Bristol, UK
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Abstract
Alcohol-related liver disease (ALD) is a major cause of liver-related morbidity and mortality. Epidemiological trends indicate recent and predicted increases in the burden of disease. Disease progression is driven by continued alcohol exposure on a background of genetic predisposition together with environmental cofactors. Most individuals present with advanced disease despite a long history of excessive alcohol consumption and multiple missed opportunities to intervene. Increasing evidence supports the use of non-invasive tests to screen for and identify disease at earlier stages. There is a definite role for public health measures to reduce the overall burden of disease. At an individual level, however, the ability to influence subsequent disease course by modifying alcohol consumption or the underlying pathogenic mechanisms remains limited due to a comparative lack of effective, disease-modifying medical interventions. Abstinence from alcohol is the key determinant of outcome in established ALD and the cornerstone of clinical management. In those with decompensated ALD, liver transplant has a clear role. There is consensus that abstinence from alcohol for an arbitrary period should not be the sole determinant in a decision to transplant. An increasing understanding of the mechanisms by which alcohol causes liver disease in susceptible individuals offers the prospect of new therapeutic targets for disease-modifying drugs. Successful translation will require significant public and private investment in a disease area which has traditionally been underfunded when compared to its overall prevalence.
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Affiliation(s)
- Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Carrier P, Girard M, Debette-Gratien M, Ouedraogo N, Loustaud-Ratti V, Nubukpo P. Liver elastometry and alcohol withdrawal: Median-term follow-up in a psychiatric unit. Alcohol 2020; 89:49-56. [PMID: 32711035 DOI: 10.1016/j.alcohol.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022]
Abstract
The measurement of liver stiffness (LS) shows promise as a follow-up tool after alcohol withdrawal, but it has mainly been studied in the early phase or in patients with severe liver disease. A 6-month ancillary study of a specific psychiatric cohort of alcoholic patients without known liver disease followed after withdrawal was conducted (Clinical Trial NCT01491347). Clinical and biological data and LS values were collected every 2 months. A total of 129 patients were included in the study; 93 had an LS assessment within the first 7 days, and 37 had all four LS measurements. Only seven (7.5%) patients had an initial LS > 12.1 kPa, the threshold used to define severe fibrosis. Abstinence was not associated with changes in LS at the various median-term follow-up periods. However, LS of abstinent subjects decreased significantly relative to that of non-abstinent subjects between M0 and M2. CAP™ values were not associated with abstinence. The systematic median-term follow-up of withdrawn patients does not appear to be contributory. However, LS could help to detect relapse in the first 2 months after withdrawal for subjects treated in a psychiatric hospital for dependence. It thus could serve as a motivation tool. Prospective studies with various and higher baseline LS values are warranted for simultaneous longitudinal assessment, including for very short- and long-term LS after withdrawal.
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Affiliation(s)
- Paul Carrier
- Fédération d'Hépatologie, Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Dupuytren, Avenue Martin Luther King, Limoges, 87025, France; INSERM Unité S-1248 Faculté de Médecine et de Pharmacie, Rue Docteur Marcland, Limoges, 87025, France; Pôle Universitaire d'Addictologie, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France
| | - Murielle Girard
- Unité de Recherche et de Neurostimulation, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France; INSERM UMR 1094/NET Faculté de Médecine et de Pharmacie, Rue Docteur Marcland, Limoges, France.
| | - Marilyne Debette-Gratien
- Fédération d'Hépatologie, Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Dupuytren, Avenue Martin Luther King, Limoges, 87025, France; INSERM Unité S-1248 Faculté de Médecine et de Pharmacie, Rue Docteur Marcland, Limoges, 87025, France; Pôle Universitaire d'Addictologie, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France
| | - Natacha Ouedraogo
- Pôle Universitaire d'Addictologie, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France
| | - Véronique Loustaud-Ratti
- Fédération d'Hépatologie, Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Dupuytren, Avenue Martin Luther King, Limoges, 87025, France; INSERM Unité S-1248 Faculté de Médecine et de Pharmacie, Rue Docteur Marcland, Limoges, 87025, France
| | - Philippe Nubukpo
- Pôle Universitaire d'Addictologie, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France; Unité de Recherche et de Neurostimulation, Centre Hospitalier Esquirol, Rue du Docteur Marcland, Limoges, 87025, France; INSERM UMR 1094/NET Faculté de Médecine et de Pharmacie, Rue Docteur Marcland, Limoges, France
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Simonetto DA, Shah VH, Kamath PS. Outpatient management of alcohol-related liver disease. Lancet Gastroenterol Hepatol 2020; 5:485-493. [PMID: 32277901 DOI: 10.1016/s2468-1253(19)30415-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Abstract
Alcohol-related liver disease has become the leading indication for liver transplantation in the USA, partly due to an increase in the prevalence of high-risk drinking behaviour and alcohol use disorder, particularly among young women. Achieving sustained alcohol abstinence might not only prevent the development and progression of alcohol-related liver disease, but could also lead to clinically significant improvements, even in the advanced stages of disease. In this Series paper, we discuss the diagnosis and outpatient management of alcohol-related liver disease, with an emphasis on treatment options for alcohol use disorder and the assessment of nutritional status.
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Affiliation(s)
- Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science Rochester, MN, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science Rochester, MN, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science Rochester, MN, USA.
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Matthews K, MacGilchrist A, Coulter‐Smith M, Jones J, Cetnarskyj R. A nurse‐led FibroScan
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outreach clinic encourages socially deprived heavy drinkers to engage with liver services. J Clin Nurs 2018; 28:650-662. [DOI: 10.1111/jocn.14660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/22/2018] [Accepted: 08/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Karen Matthews
- Centre for Liver and Digestive Disorders Royal Infirmary of Edinburgh Edinburgh UK
- Department of Nursing Centre for Applied Social Sciences Queen Margaret University Musselburgh UK
| | | | | | - Jacklyn Jones
- Department of Nutritional Science Queen Margaret University Musselburgh UK
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EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69:154-181. [PMID: 29628280 DOI: 10.1016/j.jhep.2018.03.018] [Citation(s) in RCA: 495] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
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Cook PA, Morleo M, Billington D, Sanderson-Shortt K, Jones C, Gabbay M, Sheron N, Bellis MA, Phillips-Howard PA, Gilmore IT. Evaluation of work-based screening for early signs of alcohol-related liver disease in hazardous and harmful drinkers: the PrevAIL study. BMC Public Health 2015; 15:532. [PMID: 26041363 PMCID: PMC4455281 DOI: 10.1186/s12889-015-1860-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background The direct cost of excessive alcohol consumption to health services is substantial but dwarfed by the cost borne by the workplace as a result of lost productivity. The workplace is also a promising setting for health interventions. The Preventing Alcohol Harm in Liverpool and Knowsley (PrevAIL) project aimed to evaluate a mechanism for detecting the prevalence of alcohol related liver disease using fibrosis biomarkers. Secondary aims were to identify the additive effect of obesity as a risk factor for early liver disease; to assess other impacts of alcohol on work, using a cross-sectional survey. Methods Participants (aged 36-55y) from 13 workplaces participated (March 2011–April 2012). BMI, waist circumference, blood pressure and self-reported alcohol consumption in the previous week was recorded. Those consuming more than the accepted UK threshold (men: >21 units; female: >14 units alcohol) provided a 20 ml venous blood sample for a biomarker test (Southampton Traffic Light Test) and completed an alcohol questionnaire (incorporating the Severity of Alcohol Dependence Questionnaire). Results The screening mechanism enrolled 363 individuals (52 % women), 39 % of whom drank above the threshold and participated in the liver screen (n = 141, complete data = 124 persons). Workplaces with successful participation were those where employers actively promoted, encouraged and facilitated attendance. Biomarkers detected that 30 % had liver disease (25 %, intermediate; 5 % probable). Liver disease was associated with the frequency of visits to the family physician (P = 0.036) and obesity (P = 0.052). Conclusions The workplace is an important setting for addressing alcohol harm, but there are barriers to voluntary screening that need to be addressed. Early detection and support of cases in the community could avert deaths and save health and social costs. Alcohol and obesity should be addressed simultaneously, because of their known multiplicative effect on liver disease risk, and because employers preferred a general health intervention to one that focused solely on alcohol consumption.
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Affiliation(s)
- Penny A Cook
- School of Health Sciences, University of Salford, Salford, UK.
| | - Michela Morleo
- Centre for Public Health, Liverpool John Moores University, Liverpool, UK.
| | - David Billington
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.
| | | | - Colin Jones
- Faculty of Health Education and Community, Liverpool John Moores University, Liverpool, UK.
| | - Mark Gabbay
- Health Services Research, University of Liverpool, and Brownlow Health, Liverpool, UK.
| | - Nick Sheron
- Clinical Hepatology, University of Southampton, Southampton, UK.
| | - Mark A Bellis
- College of Health and Behavioural Sciences, Bangor University, Gwynedd, UK.
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