title: Comparison of ethyl glucuronide and carbohydrate-deficient transferrin in different body fluids for post-mortem identification of alcohol use.
abstract: OBJECTIVE
  Alcohol abuse is a major risk factor for premature death. Confirming the role of alcohol consumption in cause-of-death investigations has, however, remained difficult, due to lack of reliable biomarkers.
  
  
  METHODS
  We compared ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) assays from serum, urine, cerebrospinal fluid and vitreous humor in a forensic autopsy population with either a positive (n = 38) or negative (n = 22) history of alcohol abuse based on detailed medical and police records and forensic toxicological investigations.
  
  
  RESULTS
  A positive blood alcohol concentration (median 1.15‰, range 0-3.3‰) was found in 26/38 (68%) of the cases with a documented history of alcohol abuse. EtG concentrations (mean ± SD) in urine (339 ± 389 mg/l, P < 0.001), vitreous humor (4.2 ± 4.8 mg/l, P < 0.001), serum (6.9 ± 8.9 mg/l, P < 0.01) and cerebrospinal fluid (1.7 ± 2.7 mg/l, P < 0.01) were significantly higher among the cases with a positive history of alcohol use than those in the alcohol-history negative group, whereas in corresponding comparisons CDT was significantly different only in cerebrospinal fluid (4.3 ± 2.1 vs. 2.3 ± 0.6%, P < 0.05). The highest sensitivities (92%) in detecting ante-mortem alcohol use were obtained for urine and vitreous humor EtG assays.
  
  
  CONCLUSIONS
  Our data indicate that measurements of EtG in urine or vitreous humor show the highest diagnostic accuracies in post-mortem investigations of excessive alcohol consumption and can be recommended for routine applications.
authors.affiliation: Corresponding author: Seinäjoki Central Hospital, 60220 Seinäjoki, Finland. onni.niemela@epshp.fi.
authors.forename: Juha
authors.initials: J
authors.lastname: Rainio
authors.forename: Sanna
authors.initials: S
authors.lastname: Ahola
authors.forename: Päivikki
authors.initials: P
authors.lastname: Kangastupa
authors.forename: Johanna
authors.initials: J
authors.lastname: Kultti
authors.forename: Heidi
authors.initials: H
authors.lastname: Tuomi
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: Anders
authors.initials: A
authors.lastname: Helander
authors.forename: Onni
authors.initials: O
authors.lastname: Niemelä
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000378:metabolism*; D001344:Autopsy; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid / Q000652:urine; D001826:Body Fluids / Q000378:metabolism*; D005260:Female; D005965:Glucuronates / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D014168:Transferrin / Q000031:analogs & derivatives* / Q000378:metabolism; D014822:Vitreous Body / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D005965:Glucuronates; D014168:Transferrin; C056759:carbohydrate-deficient transferrin; C093924:ethyl glucuronide