Detection Of Excessive Alcohol Consumption Research Articles

Clinical Significance of Gamma-Glutamyltranspeptidase Combined with Carbohydrate-Deficient Transferrin for the Assessment of Excessive Alcohol Consumption in Patients with Alcoholic Cirrhosis.

Background: This study aimed to compare the diagnostic performance of carbohydrate-deficient transferrin (CDT) and gamma-glutamyltranspeptidase (γ-GTP) to assess the single and combined benefits of these biological markers for the detection of chronic excessive alcohol consumption in patients with alcoholic cirrhosis. Methods: Biological markers were determined in blood samples from patients with alcoholic cirrhosis (drinking group, n = 35; nondrinking group, n = 81). The prediction accuracy of %CDT alone, γ-GTP alone, and their combination for the detection of excessive alcohol consumption was determined in patients with alcoholic cirrhosis. Results: Serum total bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-GTP, and alkaline phosphatase levels and %CDT were significantly higher and serum albumin levels were significantly lower in the drinking group than in the nondrinking group. The combination of %CDT and γ-GTP compared with %CDT or γ-GTP alone showed a higher prediction accuracy. The combination of %CDT and γ-GTP exhibited a higher specificity than γ-GTP alone. However, in terms of sensitivity, no significant difference was found between single or combined markers. Conclusions: The combination of %CDT and γ-GTP is considered a useful biomarker of chronic excessive alcohol consumption in patients with alcoholic cirrhosis.

O14: Alcohol consumption vs. hair EtG concentration in alcohol dependent individuals: Role of gender differences

Introduction Ethyl glucuronide (EtG), a minor alcohol metabolite, accumulates in hair and is proposed as a stable marker for the detection of excessive alcohol consumption above a cut-off level of 30 pg/mg hair. A correlation between drinking behavior and EtG hair concentrations is observed, but variability exists, which could partially be explained by gender differences. Aims To investigate (1) the correlation between alcohol consumption and hair EtG in alcohol dependent patients, and (2) the effect of gender differences on this correlation. Methods The first 0–3 cm hair segments were analyzed using gas chromatography mass spectrometry (GC-MS) in negative ion chemical ionization (NICI) mode. Detailed retrospective alcohol consumption was obtained on a day per day basis over the last 3 months using the Timeline Follow Back Interview in alcohol dependent individuals starting an alcohol detoxification program. Results Thirty-six Caucasian alcohol dependent individuals (25 males/11 females; mean age 45 ± 8 years; mean BMI 25 ± 6) participated. Median alcohol consumption over the last three months (90 days) was 13050 g alcohol (range 65 – 650 g alcohol/ day). Hair EtG concentrations varied between 32 pg/mg hair and 662 pg/mg hair. There was a good linear and positive correlation between hair EtG and the amounts of alcohol consumed (Pearson r = 0.83; p r = 0.82; p r = 0.78; p = 0.005). Conclusions Our data confirm the good linear correlation between hair EtG and amounts of alcohol consumed, extending findings to alcohol dependent individuals. Additionally, we show that gender differences do not play a crucial role in the interpretation of hair EtG values for evaluating the amounts of alcohol consumed. As a result, no separate cut-off values are necessary for male and female alcohol abusers. These findings should be replicated in recreational alcohol consumers to assess possible gender differences in the interpretation of lower hair EtG values.


 Diagnostic Characteristics and Application of Alcohol Biomarkers

Alcohol biomarkers play a significant role in the early diagnosis of alcohol intoxication/abuse, alcohol-related organ damages, assessment of alcoholism therapy outcomes, and in forensic medicine. Laboratory detection of excessive alcohol consumption can be carried out by direct measuring of the ethanol and/or metabolites in biological samples which is of particular importance in the cases of acute ethanol intoxication/controlling and/or monitoring of alcohol consumption, or indirectly, by using biomarkers. Preferred diagnostic characteristics of alcohol biomarkers, specificity and sensitivity dependent on the particular demands such as: prevention and treatment of alcoholism in primary and social care, criminal justice, workplace health and safety screening, trafficking control, etc. Alcohol biomarkers traditionally used in clinical practice [blood alcohol concentration (BAC), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), the ratio GGT/CDT, alanine aminotransferase (ALT), aspartate aminotransferase (AST), the rati. AST/ALT, mean cbrpuscular volume (MCV), phosphatidylethanol (PEth)] are well validated. They are used as screening/monitoring markers of acute/chronic excessive alcohol intake, alcoholism in pregnancy, and other disorders/conditions related to alcohol abuse. Numerous potential alcohol biomarkers have been discovered, but few are validated. Potential alcohol biomarkers (ethanol and serotonin metabolites, sialic acids, etc.) have good diagnostic characteristics, but their application in clinical practice is limited due to the costly equipment necessary for their measurement. Significant progress has been made in the development of sensitive and practical alcohol transdermal devices that can instantly/continuously measure BAC through human skin. Transdermal sensing of alcohol may become a valuable method for monitoring abstinence. A special aspect of alcoholism is genetic predisposition to alcohol abuse and alcoholism, or alcohol-related organ damage. Recent genome-wide association studies (GWASs) have proposed several susceptibility loci for alcohol dependence.

Comparison of ethyl glucuronide and fatty acid ethyl ester concentrations in hair of alcoholics, social drinkers and teetotallers

In previous investigations hair analysis for ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEE) proved to be suitable for the detection of excessive alcohol consumption. The aim of this study was to compare EtG and FAEE concentrations in hair of alcoholics, social drinkers and teetotallers. Hair samples from 10 alcoholics in withdrawal treatment, 11 fatalities with documented excessive alcohol consumption, four moderate social drinkers who consumed up to 20 g ethanol per day, and three strict teetotallers were analysed. After external degreasing with n-heptane, extraction with a dimethyl sulfoxide/ n-heptane mixture and headspace solid-phase microextraction of the extracts, four fatty acid ethyl esters (FAEEs) (ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) were analysed by gas chromatography–mass spectrometry (GC–MS) with deuterated internal standards. EtG was determined by GC–MS/NCI after ultrasonication of the samples with H 2O, cleanup by SPE with aminopropyl columns and PFP derivatisation. The following concentrations were measured for the four groups: teetotallers EtG < 0.002 ng/mg, FAEE 0.05–0.37 ng/mg, moderate social drinkers EtG < 0.002 ng/mg, FAEE 0.26–0.50 ng/mg, alcoholic patients EtG 0.030–0.415 ng/mg, FAEE 0.65–20.50 ng/mg and the fatalities with alcohol history EtG 0.072–3.380 ng/mg, FAEE 1.30–30.60 ng/mg. The results confirm that by using a cut-off value of the sum of FAEE > 1 ng/mg and/or a positive EtG result in hair, excessive alcohol consumption can be identified using hair analysis. However, no significant correlation between the EtG and FAEE concentrations in the positive cases could be shown. Segmental analysis of some of the specimens did not reveal the same distribution for EtG compared to FAEE in hair, and no chronological accordance compared to the self-reported alcohol consumption could be observed for both parameters. These different results of both methods are discussed in terms of differences between EtG and FAEE in mechanism of formation and incorporation into hair and elimination from hair.

Accuracy of carbohydrate-deficient transferrin in the detection of excessive alcohol consumption: a systematic review.

Excessive alcohol consumption is a common problem in society and medical practice. There is a need for a diagnostic tool with both high sensitivity and specificity for the detection of excessive alcohol consumption in unselected medical populations. Therefore, we evaluated the diagnostic accuracy of carbohydrate-deficient transferrin (CDT) in the detection of excessive alcohol consumption. Computerised literature searches in Medline, Embase and Current Contents databases (01/1966-06/2003) and reference checking. Articles on the detection of excessive alcohol consumption reporting CDT levels and self-reported alcohol consumption as a reference test were selected (n = 101). Studies concerning treatment, relapse detection and traffic offenders were excluded. Quality assessment and data-extraction was done by two reviewers independently. Only studies scoring positive on core validity criteria by Lijmer were eligible for quantitative analysis (n = 29). Only two CDT-assays (CDTect and CDTriTIA) were evaluated in more than two high validity studies fulfilling the criteria for inclusion in the statistical analysis. Sensitivity of CDTect (14 data points) ranged from 20 to 85%, whereas specificity ranged from 77 to 95%. A summary ROC curve was computed for CDTect. Sensitivity of CDTTriTIA (4 data points) ranged from 10 to 67%, and specificity ranged from 90 to 100%. No summary measure could be computed for CDTTriTIA. The heterogeneity of results could not be explained clinically. The validity of CDT as a diagnostic tool is still questionable. If the higher values for sensitivity that some studies report can be confirmed by others it is a useful diagnostic tool in unselected populations. However, more methodologically sound, comparable studies need to be performed before firm conclusions can be drawn.

A new modified γ-%CDT method improves the detection of problem drinking: studies in alcoholics with or without liver disease

Background: The detection of excessive alcohol consumption by laboratory methods continues to lack sensitivity and specificity. Recent studies have suggested that diagnostic improvement may be achieved by combining carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GT) measurements into a marker defined as γ-CDT. Methods: We developed a new approach for determining γ-CDT by using the data obtained from the Axis %CDT turbidimetric assays. Marker results were compared in the assessment of 65 alcoholics, who were either with ( n=34) or without ( n=31) liver disease, as analysed by clinical, laboratory, and morphological criteria. Reference individuals were 45 healthy volunteers who were either social drinkers or abstainers. Results: Gamma-GT and CDT results derived from both CDTect and %CDT measurements were used to calculate marker ratios as follows 0.8×ln(GT)+1.3×ln(CDT). With the established cut-off of 4.0 for the γ-%CDT, the sensitivity of this method was 94% for men and 82% for women, as compared to 61% and 46% for %CDT and 70% and 73% for GT. The γ-%CDT method was less dependent on liver status than the various other markers and showed the highest correlation with self-reported alcohol consumption ( r=0.7254). Conclusions: The data indicates that the new γ-%CDT method yields improved diagnostic accuracy for the detection of excessive ethanol consumption.

The Detection and Management of Patients with Excessive Alcohol Consumption in General Practice

Abstract: Several studies have suggested that only a minority of excessive drinkers in the population are known to their general practitioners. We have compared several methods for the detection of excessive alcohol consumption in patients in primary care. In addition we are evaluating the impact of general practitioner intervention on these patients.A self administered questionnaire, the Health Survey Questionnaire (HSQ) was mailed to 3,997 patients registered with two general practices in North West London. Replies were received from 75% of the patients. Of the respondents, 11% males, and 5% females were identified as excessive drinkers (using the limits of 42 units per week or greater for males, and 21 units per week or greater for females). In the practice where a disease register was kept, use of the HSQ resulted in more than four‐fold increase in the number of patients known to be excessive drinkers. Around 45% of the excessive drinkers expressed concern about their drinking. The HSQ compared favourably with a standard drinking interview, breath alcohol measurement and laboratory tests of excessive consumption in the detection of excessive alcohol consumption. This flexible and low cost instrument could be used to increase the detection of excessive drinkers in primary care.We are currently undertaking a pilot randomised trial of the effects of GP intervention in patients with excessive alcohol consumption involving follow up of 60 such patients over one year. A multi centre trial including around 1,000 patients from 10 group practices is planned for 1985.