Phosphatidylethanol as a sensitive and specific biomarker: comparison with gamma-glutamyl transpeptidase, mean corpuscular volume and carbohydrate-deficient transferrin.
Phosphatidylethanol (PEth), a direct ethanol metabolite, is detectable in blood for more than 2 weeks after sustained ethanol intake. Our aim was to assess the usefulness of PEth [comparing sensitivity, specificity and the area under the curve (AUC)] as compared with carbohydrate-deficient transferrin (CDT), gamma-glutamyl transpeptidase (GGT) and mean corpuscular volume (MCV), calculating the results from sober patients against those from alcohol-dependent patients during withdrawal. Fifty-six alcohol-dependent patients (ICD-10 F 10.25) in detoxification, age 43 years, GGT 81 U/l, MCV 96.4 fl, %CDT 4.2, 1400 g ethanol intake in the last 7 days (median), were included in the study. Over the time of 1 year, 52 samples from 35 sober forensic psychiatric addicted in-patients [age 34 years, GGT 16 U/l, MCV 91 fl, CDT 0.5 (median)] in a closed ward were drawn and used for comparison . PEth was measured in heparinized whole blood with a high-performance liquid chromatography method. GGT, MCV and %CDT were measured using routine methods. A receiver operating characteristic curve analysis was carried out, with 'current drinking status' (sober/drinking) as the state variable and PEth, MCV, GGT and CDT as test variables. The resulting AUC was 0.974 (P < 0.0001, confidence interval 0.932-1.016) for PEth. At a cut-off of 0.36 micromol/l, the sensitivity was 94.5% and specificity 100%. The AUC for CDT, GGT and MCV were 0.931, 0.894 and 0.883, respectively. A significant Spearman's rank correlation was found between PEth and GGT (r = 0.739), CDT (r = 0.643), MVC (r = 0.639) and grams of ethanol consumed in the last 7 days (r = 0.802). Our data suggest that PEth has potential to be a sensitive and specific biomarker, having been found in previous studies to indicate longer lasting intake of higher amounts of alcohol.
Hartmann
Susanne
S
Psychiatric University Clinic, Basel, Switzerland.
Aradottir
Steina
S
Graf
Marc
M
Wiesbeck
Gerhard
G
Lesch
Otto
O
Ramskogler
Katrin
K
Wolfersdorf
Manfred
M
Alling
Christer
C
Wurst
Friedrich Martin
FM
D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000201:enzymology / Q000534:rehabilitation; D000437:Alcoholism / Q000201:enzymology* / Q000534:rehabilitation; D015415:Biomarkers / Q000097:blood; D004909:Erythrocyte Indices; D005260:Female; D020404:Glycerophospholipids / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D014168:Transferrin / Q000031:analogs & derivatives* / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood*
D015415:Biomarkers; D020404:Glycerophospholipids; D014168:Transferrin; C056759:carbohydrate-deficient transferrin; C051521:phosphatidylethanol; D005723:gamma-Glutamyltransferase