The Formation, Elimination, Interpretation, and Future Research Needs of Phosphatidylethanol for Research Studies and Clinical Practice

Hahn, Judith A.; Anton, Raymond F.; Javors, Martin A.

doi:10.1111/acer.13213

Cited by 70 publications

(82 citation statements)

References 22 publications

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“…A recent meta-analysis reported a mean level around 2,400 ng/mL, much higher than our cohort’s median level around 900 ng/mL (Viel et al, 2012). Other factors regulating the synthesis and elimination of PEth may further contribute to variance among individuals (Hahn 2016). Our application is unique among these published investigations in that values were measured in critically ill patients, and were reflective of alcohol misuse according to AUDIT scores obtained in parallel.…”

Section: Discussionmentioning

confidence: 99%

“…The AUDIT-C, an abbreviated tool, consists of the first three full AUDIT questions quantifying alcohol consumption, and has been shown to have good test characteristics for assessing alcohol misuse in acutely ill patients (Reisinger et al, 2015). The AUDIT-C was used as another reference in this investigation to address only the questions around quantification of alcohol consumption (Hahn et al, 2016). AUDIT-C scores of ≥3 and ≥4 were used for females and males, respectively, for the lower risk limit of any misuse, while scores of ≥6 and ≥8 were used to define severe misuse (Reisinger et al, 2015, Rubinsky et al, 2013).…”

Section: Methodsmentioning

confidence: 99%

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Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients

Afshar

Burnham

Joyce

et al. 2017

Alcohol Clin Exp Res

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Background Although alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy in identifying misuse in critically ill patients is unknown. Methods PEth values were obtained in a mixed cohort comprised of 122 individuals from medical and burn intensive care units (n=33), alcohol detoxification unit (n=51), and healthy volunteers (n=38). Any alcohol misuse and severe misuse were referenced by AUDIT and AUDIT-C scores separately. Mixed effects logistic regression analysis was performed and the discrimination of PEth was evaluated using the area under the receiver operating characteristic (ROC) curve. Results The area under the ROC curve for PEth was 0.927 (95% CI: 0.877, 0.977) for any misuse and 0.906 (95% CI: 0.850, 0.962) for severe misuse defined by AUDIT. By AUDIT-C, the area under the ROC curves were 0.948 (95% CI: 0.910, 0.956) for any misuse and 0.913 (95% CI: 0.856, 0.971) for severe misuse. The PEth cut-points of ≥ 250 ng/mL and ≥ 400 ng/mL provided optimal discrimination for any misuse and severe misuse, respectively. The positive predictive value for ≥ 250 ng/mL was 88.7% (95% CI: 77.5%, 95.0%) and negative predictive value was 86.7% (95% CI: 74.9%, 93.7%). PEth ≥ 400 ng/mL achieved similar values and similar results were shown for AUDIT-C. In a subgroup analysis of critically ill patients only, test characteristics were similar to the mixed cohort. Conclusions PEth is a strong predictor and has good discrimination for any and severe alcohol misuse in a mixed cohort that includes critically ill patients. Cut-points at 250 ng/mL for any, and 400 ng/mL for severe, are favorable. External validation will be required to establish these cut-points in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients

Afshar

Burnham

Joyce

et al. 2017

Alcohol Clin Exp Res

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“…Testing PEth-positive after denying alcohol use on the baseline research interview was less common (13.1%); this may be because the participants had consented to have a breathalyzer test and blood biomarker testing to detect alcohol use, and were ensured confidentiality in the research protocol. Another study in this setting found increased self-reports after consent for alcohol biomarker testing (Hahn, et al, 2012) and other research studies found PEth-confirmed under-reporting (Bajunirwe, et al, 2014; Hahn et al, 2016). While under-reporting in any setting may be due to social desirability and recall bias, the increased level of under-reporting to clinic counselors suggests that patients may fear being denied ART (Papas et al, 2012) or some other consequence if they report drinking alcohol at the clinic.…”

Section: Discussionmentioning

confidence: 55%

“…PEth is not 100% sensitive for detecting any alcohol use (Hahn, Anton, et al, 2016) so we might have missed a few under-reporters. Lastly, the study had modest sample size, which may have reduced the power to detect statistically significant differences.…”

Section: Discussionmentioning

confidence: 99%

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Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda

et al. 2017

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Under-reporting of alcohol use by HIV-infected patients could adversely impact clinical care. This study examined factors associated with under-reporting of alcohol consumption by patients who denied alcohol use in clinical and research settings using an alcohol biomarker. We enrolled ART-naïve, HIV-infected adults at Mbarara Hospital HIV clinic in Uganda. We conducted baseline interviews on alcohol use, demographics, Spirituality and Religiosity Index (SRI), health and functional status; and tested for breath alcohol content and collected blood for phosphatidylethanol (PEth), a sensitive and specific biomarker of alcohol use. We determined PEth status among participants who denied alcohol consumption to clinic counselors (Group 1, n =104), and those who denied alcohol use on their research interview (Group 2, n =198). A positive PEth was defined as ≥8 ng/ml. Multiple logistic regression models were used to examine whether testing PEth-positive varied by demographics, literacy, spirituality, socially desirable reporting and physical health status. Results showed that, among the 104 participants in Group 1, 28.8% were PEth-positive. The odds of being PEth-positive were higher for those reporting prior unhealthy drinking (adjusted odds ratio (AOR): 4.7, 95% confidence interval (CI): 1.8, 12.5). No other factors were statistically significant. Among the 198 participants in Group 2, 13.1% were PEth-positive. The odds of being PEth-positive were higher for those reporting past unhealthy drinking (AOR: 4.6, 95% CI: 1.8, 12.2), the Catholics (AOR: 3.8, 95% CI: 1.3, 11.0) compared to Protestants and lower for the literate participants (AOR: 0.3, 95% CI: 0.1, 0.8). We concluded that under-reporting of alcohol use to HIV clinic staff was substantial, but it was lower in a research setting that conducted testing for breath alcohol and PEth. A report of past unhealthy drinking may highlight current alcohol use among deniers. Strategies to improve alcohol self-report are needed within HIV care settings in Uganda.

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Toxicological Markers of Chronic Alcohol Abuse

Pragst¹

2022

Handbook of Forensic Medicine

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The Formation, Elimination, Interpretation, and Future Research Needs of Phosphatidylethanol for Research Studies and Clinical Practice

Cited by 70 publications

References 22 publications

Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients

Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients

Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda

Toxicological Markers of Chronic Alcohol Abuse

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