Ethyl Glucuronide Elimination Kinetics in Fingernails and Comparison to Levels in Hair

Fosen, Jan Toralf; Morini, Luca; Sempio, Cristina; Giarratana, Nefele; Enger, Asle; Mørland, Jörg; Høiseth, Gudrun

doi:10.1093/alcalc/agx035

Cited by 16 publications

(13 citation statements)

References 23 publications

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“…Such EtG wash‐out effects have been proposed in previous studies as a mechanism of EtG elimination from hair. Potential wash‐out of EtG in nail have also been proposed as a possible explanation in a previously published study which showed that EtG disappeared from nails faster than it was otherwise assumed from nail growth only. Although that study used nail as a matrix, the incorporation and elimination of mechanisms is to some extent comparable to hair.…”

Section: Discussionmentioning

confidence: 96%

“…no 2013/1222). For the first 16 of the 27 patients included in the present study, longitudinal nail EtG data were also collected …”

Section: Methodsmentioning

confidence: 99%

“…longitudinal nail EtG data were also collected. 18 The inpatient treatment program at Trasoppklinikken usually lasts 10 weeks, ranging from detoxification to completing educative, cognitive behavioral, and 12-step therapy. Most patients use only alcohol, but there are no restrictions concerning other drug use/dependences.…”

Section: Introductionmentioning

confidence: 99%

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Hair EtG: Alterations in segment levels accompanying hair growth

Fosen

Høiseth

Sempio

et al. 2018

Drug Testing and Analysis

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Hair levels of the direct ethanol biomarker ethyl glucuronide (EtG) are used to evaluate history of alcohol intake. The proximal 3 cm of the hair sample is most often analyzed and this is assumed to represent the intake of ethanol over approximately the past three months. The aim of this study was to investigate change of EtG levels during hair growth in an ethanol-abstinent period. Twenty-seven patients were recruited from an alcohol treatment clinic. A hair sample was collected after hospitalization and EtG was analyzed in the 0-3 cm hair segment (T1). Another hair sample was collected after one month of abstinence and EtG was analyzed in the 1-4 cm hair segment (T2), discarding the proximal 1 cm (0-1 cm) of the segment. As a result of the segment choice and assuming a hair growth rate of 1 cm per month, T2 should represent roughly the same time of alcohol exposure as segment T1. The median concentration of EtG in T1 was 100 pg/mg (range 7.7-1320) and the median concentration in T2 was 53.4 pg/mg (range < LOQ-692). EtG concentrations decreased significantly from T1 to T2 (p = 0.003) and the median change in EtG from T1 to T2 was -46.0%. This study shows decreasing EtG concentrations in most subjects in a hair segment during growth when comparing two segments that is assumed to represent roughly the same period of alcohol intake. Further research is needed to confirm if this observed decline of EtG is a result of wash-out-effects of EtG or other factors.

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Section: Discussionmentioning

confidence: 96%

“…no 2013/1222). For the first 16 of the 27 patients included in the present study, longitudinal nail EtG data were also collected …”

Section: Methodsmentioning

confidence: 99%

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Hair EtG: Alterations in segment levels accompanying hair growth

Fosen

Høiseth

Sempio

et al. 2018

Drug Testing and Analysis

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“…Hair EtG (hEtG) reflects the alcohol consumption in the past months, depending on the analyzed hair length taking into account the growth rate of hair of approximately 1 cm/month (Crunelle et al, 2014; Pragst and Balikova, 2006). Nails grow significantly slower than hair, resulting in higher absolute concentration of EtG in nails than in hair (Fosen et al, 2017). Fosen and colleagues investigated the elimination kinetics of EtG in nail clippings in forty patients in alcohol rehabilitation.…”

Section: Figmentioning

confidence: 99%

“…Fosen and colleagues investigated the elimination kinetics of EtG in nail clippings in forty patients in alcohol rehabilitation. The half-life of nail EtG was 13.3 days (range: 5.5 to 29) and patients (n = 22) who reached negative nail EtG during the study period did that after 47.0 days (range: 13-60; Fosen et al, 2017).…”

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confidence: 99%

Diagnostic Accuracy of Biomarkers of Alcohol Use in Patients With Liver Disease: A Systematic Review

Arnts

Vanlerberghe

Roozen

et al. 2020

Alcoholism Clin & Exp Res

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Background and Aims Alcohol‐related liver disease is the most frequent cause of cirrhosis and a major indication for liver transplantation. Several alcohol use biomarkers have been developed in recent years and are already in use in several centers. However, in patients with liver disease their diagnostic performance might be influenced by altered biomarker formation by hepatic damage, altered excretion by kidney dysfunction and diuretics use, and altered deposition in hair and nails. We systematically reviewed studies on the diagnostic accuracy of biomarkers of alcohol use in patients with liver disease and performed a detailed study quality assessment. Methods A structured search in PubMed/Medline/Embase databases was performed for relevant studies, published until April 28, 2019. The risk of bias and applicability concerns was assessed according to the adapted quality assessment of diagnostic accuracy studies‐2 (QUADAS‐2) checklist. Results Twelve out of 6,449 studies met inclusion criteria. Urinary ethyl glucuronide and urinary ethyl sulfate showed high sensitivity (70 to 89 and 73 to 82%, respectively) and specificity (93 to 99 and 86 to 89%, respectively) for assessing any amount of alcohol use in the past days. Serum carbohydrate‐deficient transferrin showed low sensitivity but higher specificity (40 to 79 and 57 to 99%, respectively) to detect excessive alcohol use in the past weeks. Whole blood phosphatidylethanol showed high sensitivity and specificity (73 to 100 and 90 to 96%, respectively) to detect any amount of alcohol use in the previous weeks. Scalp hair ethyl glucuronide showed high sensitivity (85 to 100%) and specificity (97 to 100%) for detecting chronic excessive alcohol use in the past 3 to 6 months. Main limitations of the current evidence are the lack of an absolute gold standard to assess alcohol use, heterogeneous study populations, and the paucity of studies. Conclusions Urinary and scalp hair ethyl glucuronide are currently the most validated alcohol use biomarkers in patients with liver disease with good diagnostic accuracies. Phosphatidylethanol is a highly promising alcohol use biomarker, but so far less validated in liver patients. Alcohol use biomarkers can complement each other regarding diagnostic time window. More validation studies on alcohol use biomarkers in patients with liver disease are needed.

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