Improved detection of alcohol consumption using the novel marker phosphatidylethanol in the transplant setting: results of a prospective study

Abstract

Phosphatidylethanol (PEth) is a new, highly specific alcohol marker. The aim of this study was to assess its diagnostic value in the liver transplant setting. In 51 pre- and 61 post-transplant patients with underlying alcoholic liver disease PEth, ethanol, methanol, carbohydrate-deficient transferrin (CDT), and ethyl glucuronide in urine (uEtG) and hair (hEtG) were tested and compared with patients' questionnaire reports. Twenty-eight (25%) patients tested positive for at least one alcohol marker. PEth alone revealed alcohol consumption in 18% of patients. With respect to detection of alcohol intake in the preceding week, PEth showed a 100% sensitivity. PEth testing was more sensitive than the determination of ethanol, methanol, CDT or uEtG alone [sensitivity 25% (confidence interval (CI) 95%, 7-52%), 25% (7-52%), 21% (6-45%) and 71% (41-91%), respectively], or ethanol, methanol and uEtG taken in combination with 73% (45-92%). Specificity of all markers was 92% or higher. Additional testing of hEtG revealed alcohol consumption in seven patients, not being positive for any other marker. Phosphatidylethanol was a highly specific and sensitive marker for detection of recent alcohol consumption in pre- and post-transplant patients. The additional determination of hEtG was useful in disclosing alcohol consumption 3-6 months retrospectively.

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

“…Although there are interindividual variations in PEth metabolism, PEth has been validated in a study of chronic liver disease patients who had not undergone LT at a cutoff of 80 ng/mL for four drinks per day or more with a sensitivity of 91% (95% confidence interval [CI], 82%‐100%) and specificity of 77% (95% CI, 70%‐83%) . Another study of PEth use in patients with ALD before and after LT revealed a sensitivity of 100% (CI, 79%‐100%) and specificity of 96% (CI, 91%‐99%) for a cutoff of over 20 ng/mL . The performance of the current best biomarkers for alcohol use are given in Tables and .…”

“…Phosphatidylethanol (PEth) is a phospholipid formed by the reaction of phosphatidylcholine with ethanol catalyzed by phospholipase D in the erythrocyte cell membrane. (50) PEth has a half-life of approximately 10-14 days, although this can be longer with more chronic, repeated heavy alcohol consumption and does not appear to be influenced by age, body mass index (BMI), sex, kidney disease, or liver disease. (51)(52)(53)(54)(55)(56)(57) Women may have higher PEth levels for a given amount of alcohol consumption compared with men.…”

“…(59) Another study of PEth use in patients with ALD before and after LT revealed a sensitivity of 100% (CI, 79%-100%) and specificity of 96% (CI, 91%-99%) for a cutoff of over 20 ng/mL. (50) The performance of the current best biomarkers for alcohol use are given in Tables 2 and 3.…”

EASL Clinical Practice Guidelines: Management of alcohol-related liver disease

“…In addition to these already well established direct alcohol markers with high reliability, determination of other direct markers, such as EtS in urine, FAEES in hair and PEth in serum or in dried blood spots may gain increasing recognition in the future, as additional methods for confirming suspected alcohol intake. 28,[169][170][171][172][173][174][175] Suggestions for future studies…”

Applications and Challenges for the Use of Phosphatidylethanol Testing in Liver Disease Patients (Mini Review)

“…Recent applications of PEth in ALD transplant settings have been reported (Andresen‐Streichert et al., ; Fleming et al., ). In the former study (Andresen‐Streichert et al., ), 51 patients awaiting liver transplant and 61 patients posttransplant were tested for PEth against their self‐report. The authors observed that 18% of all participants tested positive for PEth suggesting alcohol exposure.…”