Diagnosis Of Alcohol Abuse Research Articles

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.

Carbohydrate-Deficient Transferrin (CDT) as a Biomarker of Alcohol Abuse: A Retrospective Study of the Italian Drinking Trend among Drivers from 2016 to 2022.

Alcohol abuse is still one of the leading causes of death worldwide. Early diagnosis of alcohol abuse enables preventive intervention on the effects and risks associated with its consumption. Carbohydrate-deficient transferrin (CDT) is one of the most reliable biomarkers of chronic alcohol misuse. We retrospectively studied a population of 12,624 subjects who had their driving license suspended for driving under the influence of alcohol or drugs from 2016 to 2022. The analytical determination of CDT was performed following a certified high-performance liquid chromatography (HPLC) method. Data were split by year, age and gender. The majority of subjects with positive %CDT were male, although the trend of positivity was similar between males and females. A steady increase in both the number of tests performed and the number of positives was observed over the years. Patients aged 41-50 years had the highest prevalence, followed by 51-60, 31-40 and 18-30 years. CDT continues to be a steady marker for diagnosis of alcohol abuse in the majority of cases. Data emerging from our study are in line with the increasing national trends on traffic accidents, injuries and deaths related to alcohol and drug DUI (driving under the influence), requiring the implementation of preventive measures to limit this ever-growing phenomenon.

Retrospective chart review of substance abuse in patients with psychiatric emergencies in an emerging urban county.

Substance abuse is common in patients with psychiatric emergencies. To further understand the connection between substance abuse and psychiatric disorders, a retrospective chart review was done that included positive drug screens among patients with psychiatric emergencies and to determine whether there was an association between substances used and the psychiatric diagnosis. A retrospective chart review of patients seen in an emergency department with psychiatric emergencies was conducted. The review comprised 1000 charts with diagnoses of anxiety, depression, schizophrenia, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, alcohol abuse, or schizoaffective disorder. Data collected included patient demographics, tobacco abuse, chief complaint, arrival mode, voluntary versus involuntary status, suicide attempt on presentation, psychiatric diagnoses, urine drug screen, and ethanol results. Chi-square statistical analysis was conducted to examine the relationship between substances of abuse and psychiatric diagnoses. Approximately 58% of patients with a history of psychiatric illness had a positive urine drug screen. Of 245 patients with schizoaffective disorder, 69 (28%) were positive for tetrahydrocannabinol (THC) and 48 (20%) were positive for cocaine. Of 225 patients with depression, 59 (29%) were positive for THC and 33 (15%) were positive for cocaine. Cannabis was the most commonly reported substance used among patients with depression, schizophrenia, anxiety, schizoaffective disorder, and bipolar disorder, and ethanol was most common in patients with ADHD. No significant correlations were found between psychiatric diagnosis and positive drug screens. A statistically significant secondary end point was found that White people using cannabinoids were more likely to attempt suicide than were African American people (P=0.02). Positive drug screens were common among patients presenting to an ED with psychiatric emergencies. Cannabis was the most commonly reported substance used among patients independent of diagnosis. Ethanol was the most common in patients with ADHD. Urine drug screens are unlikely to provide insights into relationships between specific substance use and psychiatric emergencies.

Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019

ABSTRACT Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need. Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need. Methods: The data came from the 2015–2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances. Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99). Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.

Estimating the prevalence of alcohol abuse using phosphatidylethanol

IntroductionCurrently, there is an active development of methods for the laboratory diagnosis of alcohol abuse using biochemical markers.ObjectivesThe aim of this work was to estimate the prevalence of alcohol abuse among the urban population of Belarus using the concentration of phosphatidylethanol in the blood as a biochemical marker of alcoholism.Methods220 blood samples from Grodno residents of both sexes aged 15 to 65 were analyzed. The AUDIT questionnaire was used as a screening tool. Determination of the concentration of phosphatidylethanol in the blood was carried out using the method of high performance liquid chromatography - tandem mass spectrometry (HPLC - MS).ResultsThe average concentration of phosphatidylethanol in the blood of men and women was 266.11±54.57 and 55.27±9.43 nmol/ml, respectively. In 9.6% of blood samples, the concentration of phosphatidylethanol exceeded the threshold level of alcohol abuse. It was found that the concentration of phosphatidylethanol in the blood does not correlate with the total score, as well as the frequency and quantitative characteristics of the AUDIT screening test.ConclusionsDetermining the concentration of phosphatidylethanol in the blood is a more reliable way to diagnose alcohol abuse than using screening tools.Disclosure of InterestNone Declared

Serum Carbohydrate Deficient Transferrin: A Sensitive Marker in Diagnosing Alcohol Abuse

Introduction: Alcohol is a psychoactive substance with dependence producing properties and the burden of disease and death related to alcohol consumption remains significant in most countries. Early detection and proper medication with counselling can restore the alcoholics to normalcy. There is a need for a specific assay procedure to detect alcoholics early, so that proper therapy can be instituted. The traditional biomarkers in liver function test (LFT) are more frequently used for diagnosing alcohol abuse but they have variable and limited sensitivity and specificity. Carbohydrate Deficient Transferrin (CDT) can be considered as a more sensitive and specific marker for diagnosing alcohol abuse. The aim of this study is to determine % CDT in alcoholics and compare it with other alcohol markers in respect with sensitivity and specificity. The results of the study will be helpful in assessment of the alcohol dependence patients and therefore in their early detection and management. Materials and Methods: This is a hospital based comparative cross-sectional study carried out in Dharan. A total of 40 cases of alcohol abuse with ≥2 score in CAGE questionnaire and matched 40 subjects with no history of alcohol intake were enrolled in the study. Informed written consent and ethical approval were taken. Result: Serum %CDT has the highest diagnostic efficacy followed by serum gamma glutamyl transferase (GGT), Aspartate Transaminase (AST), Alanine Transaminase (ALT), AST/AL, and ALP as a biomarker for diagnosing alcohol abuse. Serum %CDT has the highest sensitivity with 97.5% and specificity of 73% at a cut off value of 3.5% compared to serum GGT with the sensitivity and specificity of 87% and 73%, respectively at a cut off value of 33.5 U/L. Conclusion: Serum %CDT is a better marker both in terms of sensitivity and specificity compared to other conventional markers and thus can be used as a tool to early diagnose the alcoholic cases and monitor the therapy and for early identification of the relapses in alcoholics during treatment.

Ethyl Glucuronide as a Sensitive Marker of Alcohol Abuse

An important strategy for the prevention of alcohol-related problems is the early diagnosis of alcohol abuse. The present paper aims at a systematic review of the current knowledge on ethylglucuronide (EG) in blood as a direct marker of alcohol abuse.

Phosphatidylethanol (Peth) in Dried Blood Spots: Development, validation and comparison between LC-MS/MS and QTOF methods

Validation of Phosphatidylethanol (Peth) in Dried Blood Spot (DBS) technique as a biomarker for routine diagnosis of alcohol abuse. According to recent studies, alcohol abuse in the population is increasing, forcing clinical and forensic toxicology laboratories to work towards effective and quick-turnout results techniques. In this context, detecting Peth, a relatively new biomarker, with the Dried Blood Spots, a micro sampling technique based on a capillary blood drop collection on a filter paper, may be the procedure of choice. Peth is a group of phospholipids serving as direct, non-oxidative alcohol biomarkers, only formed within the human body when ethanol is present. Peth concentrations provide information about a person's drinking behavior and offer a longer alcohol detection window up to 1 month. It is applicable as a complement to Ethyl glucuronide (EtG) for the better distinguishing of alcohol abusers from social drinkers. Blank whole blood drops were spiked with Peth 16:0–18:1 at six concentration levels (20, 50, 100, 200, 300, 500 ng/mL) in three working sessions along five days. 30 μl of blood was deposited on the DBS card and left for 3 h drying at room temperature. After liquid extraction with 1 mL of hexane, the supernatant was transferred into a fresh tube prior to evaporating the solvent under a nitrogen flow at room temperature. The dry residue was reconstituted in 30 μl of acetonitrile and then injected. The detection of Peth was achieved with both UHPLC-QTOF-HRMS and UHPLC-MS/MS. Statistical evaluation of several validation parameters was executed, and the values obtained from the two different acquisition methods were found to be similar. Intra- and inter-day precision and accuracy were found to be lower than ±20% in both methods. The LOD and LOQ calculated with the Hubaux-Vos approach were 19.8 and 39.7 ng/ml for, respectively, the QTOF and the MS/MS acquisition. Recovery, matrix effect and stability parameters from the analysis of Peth and its respective internal standards Peth-D5 were evaluated. A moderate ion suppression was observed, with final values between −2.7 and −14% (tested at the 20 ng/ml level of concentration) and the method showed an extraction efficiency higher than 30% (tested at the 500 ng/mL level of concentration). The two methods were also tested with real samples within an ongoing project and their performance was compared. The extraction method and the DBS technique proved effective for the detection of Peth, with excellent results ensuring rapid assessment of the biomarker levels in whole blood. The precision calculated in the lower concentration range showed a slight upward deviation at 20 and 50 ng/ml, which is negligible when an individual is assessed for chronic alcohol abuse (in this case, tentative cut-offs are set in the range of 200–270 ng/ml). Due to the higher sensitivity obtained, the QTOF mass spectrometer proved adequate to be used for abstinence assessment in delicate clinical or forensic cases for example with newborns, organ transplant and driving relicensing. Peth in DBS combined with high resolution instrumental analysis results show great potential for routine and research analysis. Thanks to this study, a larger detection window is opened thus providing the forensic toxicology laboratories an accurate, easy, sustainable, and fast technique for the challenge of alcohol abuse diagnosis.

Transferrin analysis in wistar rats plasma: Towards an electrochemical point-of-care approach for the screening of alcohol abuse

Simple and low-cost point-of-care testing (POCT) approaches are necessary not only for the diagnosis of alcohol abuse but also for the follow-up of patients during the treatment of alcohol dependence.To advance the development towards these approaches, a disposable screen printed-based electrochemical sensor is proposed for the diagnosis of chronic alcohol abuse. The selected biomarker to be screened (and followed up) was the carbohydrate deficient transferrin (CDT), which was assessed using the parameter “Electrochemical index of glycosylation” (EIG). EIG is defined as the ratio between the signal generated by carbohydrates present in transferrin (Tf) (selectively labeled with an Os(VI) tag) and the signal generated by the electroactive amino acids present in Tf, measured by adsorptive transfer square wave voltammetry (AdTSWV). The electrochemical sensor exhibited a good limit of detection (LOD ≤ 0.7 g L−1) well below the normal range of transferrin in serum (ranging from 2 to 3.6 g L−1). In addition, the diagnostic capabilities of the sensor were evaluated in plasma rats from 31 individuals (16 chronically exposed to alcohol and 15 saline control), yielding a very good clinical sensitivity and specificity (81% and 87%, respectively).These results draw the potential of this approach to be used for POCT of alcohol abuse, making it a useful tool to help therapists/clinicians even patient’s family in the follow-up of alcohol rehabilitation.

Using Real World Data (RWD) to Identify Care Needs in an Adolescent and Young Adult (AYA) Lymphoma Population: A Match Cohort Study

Adolescent and young adult (AYA) patients with malignancies are a unique population within oncology with differences in survivorship outcomes as compared to adult and pediatric counterparts. The National Comprehensive Cancer Network (NCCN) identified eight critical domains in AYA care: mental health, cognitive function, physical exercise, fatigue, immunizations/infection prevention, pain, sexual function and sleep disorders. However, it can be difficult to establish a clinical benchmark of these domains at an institutional level without time-consuming chart review. With the advent of real-world data generated from the electronic medical record (EMR), feasible large scale data assessment can be used to identify care needs and direct future prospective studies and interventions.Here we demonstrate the feasibility of a match cohort study using EMR comparing metrics in the above NCCN domains in AYA lymphoma patients within the University of Rochester Medical Center. We identified 172 AYA lymphoma patients diagnosed between 2013 and 2019 and compared them to 516 controls over that time period using 3:1 control matching, both at time of diagnosis and one year post-diagnosis. Controls were identified within the EMR with exclusion criteria of no cancer diagnoses and fewer than an average of ten medical visits per year over the study period to control for other chronic disorders.Demographic characteristics for both groups were matched for age at diagnosis date, sex, and race. The resultant populations had an average age of 29 (SD 6), male predominance (58.72%), and Caucasian predominance (82.56%). The lymphoma group had a slightly higher rate of federally funded insurance as compared to controls (25% vs. 20%).In mental health domains, lymphoma group had a higher rate of depression at baseline (19.77% vs. 1.16%; p <0.0001) but anxiety was at comparable rates (8.72% vs. 10.85% p <0.46) with similar rates of antidepressant medication prescriptions (27.33% vs. 25.97% p < 0.75). At one year post-diagnosis, anxiety and depression rates were near identical but rates of antidepressant prescriptions had increased in the lymphoma group (30.81% vs. 22.65% p < 0.03.)In physical health domains, lymphoma group had similar rates of BMI in the overweight and obese range as compared to controls and less than five percent of the group had a sleep medicine, nutrition, or cognitive assessment at baseline or one year post-diagnosis. Vaccination rates, as measured by influenza and pneumovax adherence, were low both at diagnosis and at one year post- diagnosis in the lymphoma group (18.6% and 21.5%, respectively).In the pain domain, the lymphoma group had similarly low rates of alcohol abuse, opiate abuse and chronic pain diagnoses as compared to controls (between 1 and 4% without statistically significant differences). Interestingly, pain scores recorded at visits on the 0 to 10 scale were noticeably lower for the lymphoma group both at diagnosis and one year post-diagnosis (4.65% vs 11.24% p=0.009; 5.23% vs 11.43% p=0.02) however prescription of any analgesic medication was higher in the lymphoma group (76.16% vs. 40.98% p<0.0001; 63.95% vs. 30.62 p<0.0001).Lastly, in the reproductive and sexual health domain, the lymphoma group had high rates of consultation with reproductive endocrinology at diagnosis as compared to controls (31.40% vs. 1.74% p<0.0001) suggestive of early referral between initial suspicion of cancer and tissue diagnosis. The overall use of the services however were still at relatively low rates. Additionally, long-acting removable contraception rates, while higher in the lymphoma population (11.27% vs. 4.23 p<0.02) were still relatively low. Finally, rates of erectile dysfunction diagnoses were similar in lymphoma cases as compared to controls (0.99 vs. 0.66 p< 0.7128) without significant differences in tadalafil/sildenafil prescriptions at one year post-diagnosis (2.97% vs. 1.32% p<0.15)These data support the feasibility of using the electronic medical record to track institutional level ancillary markers of care for prospective study and population-specific interventions. Future studies will be directed at collaborations to address these care gaps and a prospective survey of AYA patients to identify patient-centered interventions improving care for this critical population. DisclosuresCasulo: Genentech: Research Funding; BMS: Research Funding; Gilead: Research Funding; Verastem: Research Funding.

An examination between treatment type and treatment retention in persons with opioid and co-occurring alcohol use disorders

Background and AimsPersons with opioid use disorder (OUD) and co-occurring alcohol use disorder (AUD) are understudied. We identified whether co-occurring AUD was associated with OUD treatment type, compared associations between treatment type and six-month treatment retention and determined whether co-occurring AUD moderated these relationships. MethodsWe used an observational cohort study design to analyze insurance claims data from 2011 to 2016 from persons aged 12–64 with an opioid abuse or opioid dependence diagnosis and OUD treatment claim. Our unit of analysis was the treatment episode; we used logistic regression for analyses. ResultsOf 211,047 treatment episodes analyzed, 14 % had co-occurring alcohol abuse or dependence diagnoses. Among persons with opioid dependence, persons with co-occurring alcohol dependence were 25 % less likely to receive medication treatment relative to those without AUD. Further, alcohol dependence was associated with decreased likelihood of treatment with buprenorphine (AOR 0.47, 95 % CI 0.44−0.49) or methadone (AOR 0.31, 95 % CI 0.28−0.35) and increased likelihood of treatment with extended-release (AOR 1.36, 95 % CI 1.21–1.54) or oral (AOR 1.73, 95 % CI 1.57–1.90) naltrexone relative to psychosocial treatment. Buprenorphine and methadone were associated with highest retention prevalence regardless of OUD or AUD severity. Co-occurring alcohol abuse or dependence did not meaningfully change retention prevalence associated with buprenorphine or methadone. Co-occurring AUD was not associated with improved retention among persons receiving either formulation of naltrexone. ConclusionsBuprenorphine and methadone are associated with relatively high likelihood of treatment retention among persons opioid and alcohol dependence, but are disproportionately under-prescribed.

Associations Between Bed Bugs and Mental Illness Among Emergency Department Patients.

BackgroundBed bugs are common urban pests associated with stress, anxiety, depression, and some reports of suicidality. The emergency department (ED) treats patients with both acute mental illness and bed bug infestations. There have been few studies examining associations between bed bug infestations and mental illness.MethodsA case-control study involving 332 adult ED patients infested with bed bugs and 4,952 uninfested control patients matched on sex, age (±1 year at the time of the ED visit), and the specific ED was completed. All clinic encounters occurred in northeast Ohio between February 1, 2011, and February 1, 2017, from a single health system. Univariable and multivariable regression analysis looked for associations between bed bug infestation and different psychiatric diagnoses and medications.ResultsBed bug infested patients were more likely than uninfested patients to screen positive for an unsafe home and needing an abuse consult at ED triage (P≤.03 for both). ED psychiatric evaluations were not significantly more common among those with (2.4%) and without (1.3%) bed bugs (P=.14). Bed bug infested patients were significantly more likely to have an ED or inpatient diagnosis of alcohol abuse and psychosis (P≤.03 for both), but not for depression or suicidality. On univariable analysis, among ED patients not admitted to the hospital, bed bug infested patients were more likely to be diagnosed with psychosis or schizophrenia/schizoaffective disease (P≤.02) than uninfested patients. Among ED patients that received an ED or inpatient psychiatric evaluation and were admitted to the hospital, bed bug infested patients were significantly less likely to be diagnosed with depression and suicidality (P≤.03 for both). However, they were not significantly more likely to have insomnia or anxiety.DiscussionAmong ED patients, bed bug infestations were not associated with an ED or inpatient diagnosis of depression or suicidality. On univariable analysis, some mental health diagnoses such as anxiety and insomnia were more common among ED patients with bed bugs, but these associations were no longer significant on multivariable analysis. These associations likely reflect the complex relationships between socioeconomic factors, health disparities, mental illness, and having a bed bug infestation.

Patient Outcomes Following Opioid Dose Reduction Among Patients with Chronic Opioid Therapy

Research ObjectiveThe impact of prescribing initiatives that encourage dose reductions is still largely unknown. Our objective was to determine whether the degree of opioid dose reduction among patients with high‐dose chronic opioid treatment (COT) associates with suicide, opioid overdose, other opioid‐related adverse events, or buprenorphine fills.Study DesignIn this retrospective cohort study, we identified patients with COT in 2014 or 2015 with 12 months of follow‐up to determine opioid dose trajectory and an additional 12 months of follow‐up to identify outcomes. We characterized dose trajectories in 12 months after a period of COT as abrupt discontinuation, dose reduction with discontinuation, dose reduction without discontinuation, and no dose reduction or discontinuation. We also characterized the effect of patient demographics (age, race, gender, rural vs. urban), prescription profile during COT, and diagnoses of alcohol abuse, depression, or any drug abuse. Multivariate logistic regression was used to examine the effect of dose trajectories on suicide (fatal or non‐fatal), opioid overdose (fatal or non‐fatal), other adverse events, and buprenorphine fills in the following year. Other adverse events included a diagnosis of adverse effects, opioid abuse, opioid dependence, or unspecified opioid use diagnosed in outpatient, inpatient (hospital), or emergency department settings.Population StudiedWe studied 17,990 continuously enrolled Medicaid recipients in Oregon with high‐dose COT. All analyses used the Oregon Medicaid claims data linked with the Oregon Prescription Drug Monitoring Program (PDMP) and vital statistics data sets covering calendar years 2014 to 2017.Principal FindingsIn the 12 months after the high‐dose COT period, there were 1,328 (7.38%) individuals with an abrupt discontinuation, 2,953 (16.41%) with a dose reduction with discontinuation, 4,282 (23.8%) with a dose reduction without discontinuation, and 9,427 (52.40%) with no dose reduction or discontinuation. Patients who abruptly discontinued had the highest odds of fatal or nonfatal suicide (adjusted odds ratio (aOR) 12.1, 95% confidence interval (CI) 3.5, 41.6), fatal or nonfatal overdose (aOR 2.6, 95% CI 1.4, 4.7), or other adverse events (aOR 2.0, 95% CI 1.4, 2.7). Among those who had an opioid overdose, patients who discontinued opioid use after COT were more likely to overdose on heroin than those who did not discontinue opioid use (P &lt; .0001). Among those with a suicide or opioid overdose event, patients with a dose reduction and discontinuation were more likely to experience a fatal event compared to those with an abrupt discontinuation or no discontinuation (P &lt; .0001). Patients with a dose reduction and discontinuation were most likely to have filled at least one buprenorphine prescription during the follow‐up period (n = 177, 6.0%, P &lt; .0001) when compared to all other dose trajectory groups.ConclusionsRapid dose reduction or discontinuation after COT increased the odds of suicide, overdose, or other adverse events, while the odds of each type of event were highest among those with an abrupt discontinuation.Implications for Policy or PracticeOur study suggests that patients on high‐dose COT require careful risk assessment and supportive interventions when initiating opioid dose reduction or discontinuation.Primary Funding SourceCenters for Disease Control and Prevention

National Trends of Arrhythmia Hospitalizations and Comorbid Alcohol Use Disorders in the United States.

ObjectiveTo study the trends of arrhythmia hospitalizations with comorbid alcohol use disorders (AUDs) in terms of demographic characteristics and inpatient outcomes.MethodsWe used the Nationwide Inpatient Sample (NIS) data from 2010 to 2014 and included 570,556 arrhythmia inpatients (age, 15-54 years), and 55,730 inpatients had comorbid AUD. We used the linear-by-linear association test for measuring the differences in demographics, comorbidities, and hospital outcomes over the study period of 2010 to 2014, and the analysis of variance (ANOVA) for measuring the changes seen in the length of stay (LOS) and total charges.ResultsArrhythmia inpatients with AUD were majorly males (85.9%), and older-age adults (45 to 54 years, 68%). Hypertension (52.2%), tobacco abuse (42.3%), and elevated cholesterol and lipids (22.6%) were the most prevalent comorbidities in the study population. There was a statistically significant increasing trend in arrhythmia inpatients with AUD with comorbid diabetes, hypertension, and obesity over the five-year period. In-hospital mortality had a variable trend from 1.1% in 2010 to 1.3% in 2014, but there was a statistically non-significant difference in the trend (P = 0.418). Mean LOS was three days with statistically no significant change during the study period (P = 0.080), whereas total charges have been increasing significantly (P <0.001), averaging $37,473 per hospitalization.ConclusionThe prevalence trend of arrhythmia hospitalizations with comorbid AUD is increasing in the United States population, and is majorly seen in older-age men. Overall, in-hospital mortality in arrhythmia inpatients with comorbid AUD was 1.4%. So, this necessitates the development of an integrated clinical care model for early diagnosis and management of alcohol abuse and dependence in order to improve the arrhythmia patient outcomes and quality of life.

Psychiatric Comorbidity and Outcomes After Left Ventricular Assist Device Implantation for End-Stage Heart Failure

BackgroundPsychiatric comorbidities play a key role in patient selection for left ventricular assist devices (LVADs), but their impact on clinical outcomes is unknown. ObjectivesThe goal of this study was to examine the clinical impact of psychiatric illness on outcomes in patients receiving LVADs for end-stage heart failure (HF). MethodsThe study identified adults in the Interagency Registry for Mechanically Assisted Circulatory Support with psychiatric comorbidities (history of alcohol abuse, drug use, narcotic dependence, depression, and other major psychiatric diagnoses) receiving continuous-flow LVADs from 2008 to 2017. Demographic characteristics, survival, adverse events, and quality of life scores were compared for patients with and without each psychiatric comorbidity. ResultsOver the study period, the prevalence of psychiatric comorbidities was low: alcohol abuse, n = 1,093 (5.5%); drug use, n = 1,077 (5.4%); narcotic dependence, n = 96 (0.5%); depression, n = 401 (2.0%); and other major psychiatric illnesses, n = 265 (1.4%). Narcotic dependence (adjusted hazard ratio: 1.9; 95% confidence interval: 1.2 to 3.0; p = 0.004) and other major psychiatric illnesses (adjusted hazard ratio: 1.4; 95% confidence interval: 1.0 to 1.9; p = 0.02) were associated with increased risk of mortality, whereas alcohol abuse, drug use, and depression were not. All comorbidities except narcotic dependence were associated with increased risk of rehospitalization and device-related infection (both p < 0.05). Kansas City Cardiomyopathy Questionnaire scores were lower from 6 to 24 months’ post-implantation among patients with psychiatric comorbidities (p < 0.05). ConclusionsDespite a low prevalence of psychiatric comorbidities among LVAD recipients, these conditions were associated with mortality risk, adverse events, and poorer quality of life. Further study is needed to understand how specific psychiatric conditions affect outcomes and how to best manage this vulnerable patient population.

4269 Frequent emergency department use among homeless individuals seen in emergent care: High risks of opioid-related diagnoses and adverse health services utilization outcomes

OBJECTIVES/GOALS: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes. METHODS/STUDY POPULATION: Based on the State Emergency Department Database and the State Inpatient Database, homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons). RESULTS/ANTICIPATED RESULTS: Higher rates of ED use were associated with Medicare coverage &lt;65; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit (2.8% vs. 2.8% vs. 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.

18 Characteristics and 30-Day Outcomes of Acute Pancreatitis Admissions According to Etiology: A Nationwide Analysis

INTRODUCTION: Acute pancreatitis (AP) is a frequent cause of hospitalization in the United States. The major etiologies of AP are alcohol, choledocholithiasis, and drug-induced. We aim to describe demographic, clinical, and admission characteristics of AP hospitalizations according to etiology. In addition, we compared in-hospital and 30 day mortality and readmission outcomes among the three major AP subtypes. METHODS: We performed a retrospective analysis of the 2016 National Readmission Database. Hospital admissions of adults (&gt;18 years of age) with the primary or secondary discharge diagnosis of AP. Specific ICD-10 codes were used to classify AP into biliary pancreatitis (K851), alcoholic pancreatitis (K852), and drug-induced pancreatitis (K853). Patients with nonspecific AP codes were classified as biliary pancreatitis if they had a concomitant diagnosis of cholelithiasis and as alcoholic AP if they had a diagnosis of alcohol abuse. Non-specific AP admissions were excluded. Characteristics and 30-day outcomes of the three groups were compared using the X-square test for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. RESULTS: A total of 81,382 admissions met the inclusion criteria: 32,459 had biliary AP, 46,438 alcoholic AP, and 2,485 drug-induced AP. Patients with alcoholic AP were more likely to be male (69.1%) and younger (mean age 46.6) compared to the other groups. Patients with biliary AP were more likely to develop cholangitis (1.8%) compared to the other groups (≤0.2%). HIV was more associated with drug-induced pancreatitis (1.4%) compared to the other groups (≤0.4%). Mean length of stay was longest (5.9 days) and mean costs were highest ($15,367) in biliary AP. These were lowest in drug induced AP (4.2 days and $9413, respectively). In-hospital mortality (0.9%) and 30-day mortality (1.3%) was highest in biliary AP compared to the other groups. Thirty day- readmissions were highest in alcoholic AP (14.3%) compared to drug induced AP (11.5%) and biliary AP (10.1%). CONCLUSION: In this large, nationally representative patient sample, drug induced AP had the lowest length of stay and costs, while alcoholic AP had the highest 30-day readmission rates (14.3%). Biliary pancreatitis was associated with the highest in-hospital and 30-day mortality. Knowledge of these findings may allow us to design and target future studies to mitigate the high readmission rates in alcoholic pancreatitis, and the complications and mortality in biliary pancreatitis.

Predicting Persistent Opioid Use, Abuse and Toxicity Among Cancer Survivors

While opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. An individualized assessment of benefits and risks is required for optimal management with opioids. Current guidelines for risk stratification, however, are based on expert opinion or instruments validated in non-oncology cohorts that omit numerous relevant factors for cancer patients. The purpose of this study was to develop and validate a model to predict the risk of persistent opioid use, abuse and toxicity among cancer survivors. This study used a retrospective cohort of 106,732 non-metastatic cancer survivors with non-hematologic or cutaneous malignancies (bladder, breast, colon, esophagus, stomach, head and neck, kidney, liver, lung, pancreas, prostate, or rectal) from the Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI) database. We determined rates of persistent opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity by cancer type. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors for persistent opioid use. Predictive models for persistent opioid use, opioid abuse, and opioid related admissions were developed using least absolute shrinkage and selection operator (LASSO) regression and tested in an independent validation cohort. The prevalence of persistent opioid use in cancer survivors was 8.3% overall and 6.2% among opioid-naïve patients with a new prescription during treatment. Rates of opioid abuse or dependence and opioid related admissions were 2.9 and 2.1%, respectively. Advanced age (HR: 0.71 [per 10 years], 95% CI: 0.6-0.74), black race (0.76, 0.71-0.81), employment (0.67, 0.61-0.74) and living in a zip code with a higher median income (0.97, 0.97-0.99) were associated with a decreased adjusted risk for persistent use. Prior diagnoses of alcohol abuse (1.11, 1.03-1.19), non-opioid drug abuse (1.07, 0.97-1.18), opioid drug abuse (1.39, 1.2-1.6), depression (1.46, 1.37-1.55) and increased preexisting comorbidities (1.21 [CCI ≥ 3], 1.21-1.3) were associated with increased adjusted risk. Validation of the predictive models in an independent test set showed a high level of accuracy in predicting persistent opioid use (AUC: 0.869), future diagnoses of opioid abuse or dependence (0.883) and admission for opioid abuse or toxicity (0.785). Patient-specific risks of persistent opioid use, opioid abuse, and opioid related admissions can be estimated for cancer survivors. Personalized risk stratification should be used to guide management when prescribing opioids in cancer patients.

The role of depression in unnatural death: A case-based retrospective study

BackgroundDepression affects the life of millions around the globe and perhaps also the manner of death. This study examined the role of depression in specific causes of unnatural death and whether alcohol and substance use affect this relationship, in one locality in Scotland. MethodsThe research used a retrospective case-based study approach to analyse 168 cases, quantifying data reported in mortuary files to allow for quantitative statistical analysis of associations and differences amongst the variables. ResultsA diagnosis of depression was associated with a higher likelihood of unnatural death due to suicide, drugs or homicide. A diagnosis of substance abuse was associated with a diagnosis of depression and with an increased likelihood of death due to suicide or drugs. A diagnosis of alcohol abuse was associated with a reduced likelihood of a diagnosis of depression but was associated with an increased likelihood of suicide. LimitationsThis study relied on a small sample from one locality in Scotland which limited the ability to generalise the results and the retrospective case-based design also limited the potential for checking data accuracy or to consider temporal relationships, which limited the ability to interpret causality. ConclusionsThis study found that there was a relationship between depression and unnatural death, which was mediated by alcohol and substance use. The importance of this study lies within the recognition of these relationships which identified the complexities of these relationships but suggested that some unnatural deaths within this population could be prevented.

A novel low-cost approach for the semi-quantitative analysis of carbohydrate-deficient transferrin (CDT) based on fluorescence resonance energy transfer (FRET)

Background and aimThe increase of the carbohydrate-deficient transferrin (CDT) as results of an heavy intake of alcohol for at least two weeks, is a well-known biochemical modification since the middle ‘70s. Notwithstanding the first commercial kit for the diagnosis of chronic alcohol abuse based on this biomarker was commercially accessible already thirty years ago, only expensive analytical methods are currently available for its determination. The present paper shows a new approach intrinsically sensitive and specific, based on a specific derivatization of transferrin, and not requiring sophisticated instrumentation. MethodsThe proposed procedure is based on a selective chelation of terbium (III) by transferrin followed by detection using an characteristic Fluorescence Resonance Transfer Energy (FRET) phenomenon (ex 298 nm - em 550 nm). ResultsThe proposed procedure showed a limit of detection of 2.5 pmol/mL and a reproducibility intra-day and inter-days <15% and 20%, respectively. The results obtained analyzing 40 serum samples using the developed method, were compared with those obtained with HPLC-Vis and an R2 = 0.8854 was found. ConclusionsConsidering its main features (low-cost, ease of operation, minimum need of instrumentation) the present method is suitable for application in screening contexts and in non-strictly regulated environments (e.g. clinical diagnosis) as well as in developing countries or remote areas.