title: Urinary ethyl glucuronide as a novel screening tool in patients pre- and post-liver transplantation improves detection of alcohol consumption.
abstract: Optimal selection of liver transplant candidates and early detection of alcohol relapse after orthotopic liver transplantation (OLT) is necessary to improve long-term outcomes. In this study, urinary ethyl glucuronide (uEtG) was prospectively evaluated as a novel screening tool for alcohol detection in the transplant setting. Overall, 141 liver transplant candidates and recipients, visiting the outpatient clinic for a total of 308 times, were included. At each visit, the alcohol markers, uEtG, ethanol, methanol, and carbohydrate-deficient transferrin (CDT), as well as the state markers, alanine transaminase, aspartate transaminase, gamma glutamyl transpeptidase (GGT), and mean corpuscular volume (MCV), were determined, then compared to patients' self-reports on alcohol intake. Urinary EtG significantly increased the detection rate of alcohol consumption, compared to the other alcohol markers (P < 0.001). In 93% of patients and at 92.5% of visits with positive alcohol markers, alcohol intake was detected by uEtG and/or CDT. Sensitivity and specificity of uEtG were 89.3% and 98.9% and of CDT were 25% and 98.6%, respectively. Urinary EtG was the best independent predictor of alcohol consumption in univariate and multivariate analysis (positive predictive value: 89.3%; negative predictive value: 98.9%; odds ratio: 761.1; P < 0.001). It showed a superior prediction rate, when compared to established alcohol and state markers, as well as to the combination of CDT with MCV and GGT, assessed by net reclassification improvement (NRI) (NRI: 1.01, P < 0.001; NRI: 1.755, P < 0.001).
  
  
  CONCLUSIONS
  uEtG is a sensitive, specific, and reliable marker for the detection of recent alcohol intake pre- and post-OLT. In combination with CDT, uEtG should be considered as a tool for routine alcohol screening within the transplant setting.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Katharina.Staufer@meduniwien.ac.at
authors.forename: Katharina
authors.initials: K
authors.lastname: Staufer
authors.forename: Hilke
authors.initials: H
authors.lastname: Andresen
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Niels
authors.initials: N
authors.lastname: Tobias
authors.forename: Bjoern
authors.initials: B
authors.lastname: Nashan
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000652:urine*; D005260:Female; D005965:Glucuronates / Q000652:urine*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis / Q000601:surgery / Q000652:urine; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D013695:Temperance; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D005965:Glucuronates; C093924:ethyl glucuronide