335 Correlation Between a Direct Alcohol Biomarker, Phosphatidylethanol, and the Alcohol Use Disorders Identification Test

Abstract

All Level 1 trauma centers are mandated to provide alcohol screening, brief intervention and referral to treatment to trauma patients. An innovative method for alcohol screening and testing is the analysis of a biologically occurring marker: phosphatidylethanol (PeTH). PeTH cells accumulate in the blood due to ethanol exposure and can be detected through an enzyme-linked immunosorbent assay. We aimed to assess the correlation between PeTH levels and self-reported Alcohol Use Disorders Identification Test (AUDIT) scores. Given the known limitations of AUDIT, we hypothesize that we will not find any correlations between AUDIT scores and PeTH levels. This is a prospective, cohort study conducted at an urban, Level 1 trauma center/emergency department (ED) from April 2013 to February 2018. PeTH levels and AUDIT scores from 90 ED subjects were collected. We analyzed patient demographic information via descriptive statistics. The association of PeTH levels with AUDIT scores were studied by 1-way analysis of variance (ANOVA). To determine the correlations between PeTH levels and AUDIT scores, we analyzed the Spearman’s Rho coefficients for each correlation. Domain One questions, the first 3 questions in the AUDIT questionnaire, were specifically analyzed to determine alcohol use behaviors in the enrolled patients. Majority of the 90 subjects were male, Hispanic, unemployed, single, and under Medi-Cal insurance. The average age of subjects was 42 years with a standard deviation (SD) of 15 years. We observed similar age distributions in both sexes. Our cohort consisted of 59 patients with AUDIT scores of 0-7, 23 patients with AUDIT scores of 8-15, 5 patients with AUDIT scores of 16-19, and 3 patients with AUDIT scores of 20 and above. The mean PeTH level was 157.74 nanograms/deciliter (SD 196.69 nanograms/deciliter). Our results demonstrate no correlations between serum PeTH levels and AUDIT scores when we evaluated PeTH as a continuous or categorical variable. When we focused our analysis on Domain One questions, we also did not observe any correlations between the PeTH levels and Domain One AUDIT scores. Our results are not consistent with previous literature. The mixed results of correlations between AUDIT and PeTH levels indicate that AUDIT does have limitations, which may include the social context of the examined ED population. Future research may focus on developing a composite score, using multiple modalities, to screen for alcohol misuse behaviors.TablePhosphatidylethanol Level Cutoff (253 nanograms/deciliter) Versus the Alcohol Use Disorders Identification Test: Categorical AnalysisAUDIT ScoresP-value0-78-1516-1920+Total.485PeTH Level Cutoff≤ 253.000 ng/dlCount50193274% within AUDIT Categorized84.7%82.6%60.0%66.7%82.2%> 253.001 ng/dlCount (N)942116% within AUDIT Categorized15.3%17.4%40.0%33.3%17.8%TotalCount (N)59235390% within AUDIT Categorized100%100%100%100%100%Abbreviations: PeTH: phosphatidylethanol, AUDIT: Alcohol Use Disorders Identification Test; N: sample size; ng/dl: nanograms/deciliter Open table in a new tab