title: Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers.
abstract: BACKGROUND
  Ethyl glucuronide (EtG) in hair has emerged as a useful biomarker for detecting alcohol abuse and monitoring abstinence. However, there is a need to establish a reliable cutoff value for the detection of chronic and excessive alcohol consumption.
  
  
  METHODS
  One hundred and twenty-five subjects were classified as teetotalers, low-risk drinkers, at-risk drinkers, or heavy drinkers. The gold standard for subjects' classifications was based on a prospective daily alcohol self-monitoring log. Subjects were followed for a 3-month period. The EtG diagnostic performance was evaluated and compared with carbohydrate-deficient transferring (CDT) and the activities of aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl-transferase (γGT).
  
  
  RESULTS
  A cutoff of >9 pg/mg EtG in hair, suggesting an alcohol consumption of >20/30 g (at-risk drinkers), and a cutoff of >25 pg/mg, suggesting a consumption of >60 g (heavy drinkers), were determined by receiver operating characteristic analysis. The EtG diagnostic performance was significantly better (P < 0.05) than any of the traditional biomarkers alone. EtG, as a single biomarker, yielded a stronger or similar diagnostic performance in detecting at-risk or heavy drinkers, respectively, than the best combination of traditional biomarkers (CDT and γGT). The combination of EtG with traditional biomarkers did not improve the diagnostic performance of EtG alone. EtG demonstrated a strong potential to identify heavy alcohol consumption, whereas the traditional biomarkers failed to do so. EtG was not significantly influenced by gender, body mass index, or age.
  
  
  CONCLUSIONS
  Hair EtG definitively provides an accurate and reliable diagnostic test for detecting chronic and excessive alcohol consumption. The proposed cutoff values can serve as reference for future cutoff recommendations for clinical and forensic use.
authors: University Center of Legal Medicine, Lausanne-Geneva, rue du Bugnon 21, 1011, Lausanne, Switzerland.
authors: Hicham
authors: H
authors: Kharbouche
authors: Mohamed
authors: M
authors: Faouzi
authors: Nathalie
authors: N
authors: Sanchez
authors: Jean Bernard
authors: JB
authors: Daeppen
authors: Marc
authors: M
authors: Augsburger
authors: Patrice
authors: P
authors: Mangin
authors: Christian
authors: C
authors: Staub
authors: Frank
authors: F
authors: Sporkert
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000032:analysis; D000428:Alcohol Drinking / Q000097:blood; D000437:Alcoholism / Q000097:blood / Q000175:diagnosis*; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000302:isolation & purification; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005965:Glucuronates / Q000302:isolation & purification*; D006197:Hair / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015813:Substance Abuse Detection / Q000379:methods*; D014168:Transferrin / Q000031:analogs & derivatives / Q000302:isolation & purification; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000302:isolation & purification
chemical_list: D015415:Biomarkers; D005965:Glucuronates; D014168:Transferrin; C056759:carbohydrate-deficient transferrin; C093924:ethyl glucuronide; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase