One Year Clinical Correlates of EtG Positive Urine Screening in Alcohol-Dependent Patients: A Survival Analysis.
OBJECTIVE
Little evidence exists supporting the efficacy of regular alcohol urine screening (RAUS) in the management of alcohol dependence, despite recent improvements in urine biomarkers. In this study, we aimed at investigating 1 year, differential clinical correlates between a positive and a negative baseline urine ethyl glucuronide (EtG) screening.


METHODS
Alcohol-dependent outpatients participating in a previous cross-sectional study where EtG and ethanol diagnostic performances were compared in a double blind design were included. After 1 year, the presence of relapse, the number of hospitalizations and whether patients had abandoned treatment or not were assessed from electronic medical records. A survival analysis was conducted to compare time to relapse between EtG negative and positive subjects. Regression models were performed to compare the mean number of days hospitalized between groups, the risk of being lost to follow-up and treatment expenses.


RESULTS
Of note, 152 patients (mean age 52, 67% males) were included. The mean time to relapse was of 163 days in EtG positive subjects, compared to 329 days in those with a negative result. In the Cox-regression model, only EtG positivity yielded significant results, with a hazard ratio of 5:3 (95% CI: 3.1-9.1). EtG positive was also the only significant predictor of a greater number of hospitalization days and treatment expenses. Younger age was the only variable predicting a greater risk of treatment abandonment.


CONCLUSIONS
RAUS with sensible biomarkers could improve clinicians' ability to assess patients' relapse risk. Further prospective studies will have to determine if this can be translated into a better prevention capacity.


OBJECTIVE
Positive urine screenings, when conducted with highly sensible alcohol biomarkers, significantly indicate a greater risk of relapse in alcohol-dependent patients and have the capacity to predict a greater risk of hospitalization and greater treatment expenses.
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain.|Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain.|Grup de Recerca en Addiccions Clínic. Hospital Clínic de Barcelona. IDIBAPS. Universitat de Barcelona. Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain.
Pablo
P
Barrio
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain.
Silvia
S
Mondon
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain.
Lídia
L
Teixidor
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain.
Lluisa
L
Ortega
Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain.|Centro de Investigación en Red de Salud mental (CIBERSAM) Pabellón 11 28029, Madrid, Spain.|Bipolar Disorder Program, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170 08036 Barcelona, Spain.
Eduard
E
Vieta
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain.|Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain.|Grup de Recerca en Addiccions Clínic. Hospital Clínic de Barcelona. IDIBAPS. Universitat de Barcelona. Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain.
Antoni
A
Gual
D000437:Alcoholism / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D001944:Breath Tests / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D005965:Glucuronates / Q000652:urine*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D012008:Recurrence; D015813:Substance Abuse Detection / Q000379:methods / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors
D015415:Biomarkers; D005965:Glucuronates; C093924:ethyl glucuronide