Monitoring of direct alcohol markers in alcohol use disorder patients during withdrawal treatment and successive rehabilitation

Abstract

Direct and indirect biomarkers are widely applied for the determination of alcohol consumption. They help to assess past or present alcohol consumption. Depending on the window of detection and sensitivity of the investigated marker, punctual alcohol consumption may remain undetected. In this study, different sampling strategies for the intermediary long‐term marker phosphatidylethanol (PEth) are evaluated and compared to the determination of the short‐term markers ethyl glucuronide (EtG) and ethyl sulfate (EtS) in urine. Samples from 19 patients undergoing alcohol use disorder treatment were collected during the withdrawal treatment and successive rehabilitation (33 ± 26 days (range: 3–74 days)). With liquid chromatography–tandem mass spectrometry (LC–MS/MS) EtG and EtS in urine, PEth in blood, PEth in dried blood spot (DBS) from venous blood, and PEth in DBS from capillary blood were quantified and compared. The use of volumetric capillary DBS, prepared from 20 μL of blood, provided the same results as the use of venous DBS (95% ± 10%, R2 0.9899 for PEth 16:0/18:1). Capillary DBS sampling has the advantage that it can be performed without venipuncture. The use of PEth in DBS proved to prevent post‐sampling degradation, providing a longer detection in comparison to PEth in liquid blood, which only showed 67% ± 24% of the PEth DBS 16:0/18:1 concentration. When compared with EtG and EtS in urine, PEth monitoring proved to be advantageous for the detection of relapse situations, as the accumulation of PEth in blood prolongs the detectability. In conclusion, volumetric capillary DBS sampling for PEth is a simple and useful tool for compliance monitoring, and avoids hematocrit issues.

Integration of an Addiction Team in a Liver Transplantation Center

“…The first patient was in denial of the alcohol abuse, which persisted despite a liver biopsy that showed recurrence of alcohol‐related cirrhosis. This situation again highlights the relevance of biomarkers of alcohol consumption in the follow‐up of LT patients . The second patient was very young, with a life‐threatening emergency due to acute liver failure.…”

Phosphatidylethanol Reliably and Objectively Quantifies Alcohol Consumption in Adolescents and Young Adults

“…DBS was generated using DBS bioanalysis cards on the day of collection from lithium‐heparinized venous blood samples (v‐DBS). After DBS generation according to a standard operation procedure (Luginbühl et al, 2019b), the cards were folded shut and placed in a ziplock bag along with a silica gel drying agent. These were stored at −20°C for a maximum of 8 days, before being shipped at room temperature to the cooperating laboratory (Institute of Forensic Medicine, University of Bern, Switzerland).…”

“…For the participants from the drug and alcohol treatment center, capillary blood was used and DBS was immediately generated (c‐DBS), prior to storage under the same conditions as the v‐DBS and shipment to the cooperating laboratory (Luginbühl et al, 2019b). All of the questionnaires were completed on the same day as c‐DBS generation.…”

“…Establishing PEth as a reliable and objective marker of alcohol consumption in adolescents would be beneficial for sensitive circumstances with a potential social desirability bias, such as binge‐drinking youths or those with a prior criminal record (Richter and Johnson, 2001). PEth could also be useful during alcohol withdrawal treatment and relapse monitoring, as suggested for adult populations (Luginbühl et al, 2019b). We hypothesize PEth to be a feasible direct biomarker for these purposes.…”

Comparing Alcohol Use Disorders Identification Test (AUDIT) with Timeline Follow Back (TLFB), DSM-5 and Phosphatidylethanol (PEth) for the assessment of alcohol misuse among young people in Ugandan fishing communities

“…DBS samples were kept at −20 °C in the Bern laboratory and analysed within five to seven days of arrival to avoid degradation of PEth. Assays of the main PEth homologues (16:0/18:1 and 16:0/18:2), in human blood (Hill-Kapturczak et al, 2019) were conducted using high-performance liquid chromatography-tandem mass spectrometry (LC–MS/MS) as described elsewhere (Luginbühl, Weinmann, Butzke, & Pfeifer, 2019). Detection of PEth is associated with active excessive drinking in the previous 3–4 weeks.…”